Patient Resources 9 min read·Updated 22 July 2026 Clinician-reviewed

Advance Care Planning in CKD

A UK Consultant Nephrologist's guide to making your wishes known about future treatment — for everyone with CKD, not just those approaching end-stage disease.

  • Clinically Reviewed
  • NHS & NICE Aligned
  • UK Evidence-Based
  • Last Reviewed 22 July 2026

Professor Mohammed Mahdi Althaf

Consultant Nephrologist & Acute Physician

View Credentials

Professor Mohammed Mahdi Althaf

MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN

Consultant Nephrologist & Acute Physician · GMC 7216325

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Direct answer

Advance care planning is for anyone with CKD, at any stage. The four key tools in the UK: ReSPECT form, Advance Decision to Refuse Treatment (ADRT), Lasting Power of Attorney (Health), and a Statement of Wishes. None of them shorten life — they ensure your voice is heard.

Key recommendation: ReSPECT form: records emergency care wishes incl. CPR.

Quick answer

✓ Best choices

  • Home-cooked meals built around vegetables and whole grains
  • Lower-potassium fruit between meals
  • Hydration spread across the day (within your fluid allowance)
  • Movement most days — even a 20-minute walk

✓ Foods to limit

  • Ultra-processed snacks and ready meals
  • Sugary and energy drinks
  • Salt at the table

Key takeaway

Advance care planning is for anyone with CKD, at any stage. The four key tools in the UK: ReSPECT form, Advance Decision to Refuse Treatment (ADRT), Lasting Power of Attorney (Health), and a Statement of Wishes. None of them shorten life — they ensure your voice is heard.

Who should be cautious

People on dialysis, post-transplant, pregnant or breastfeeding, or taking prescription medication — confirm with your renal team before changes.

Advance Care Planning in CKD

Why ACP matters in CKD

CKD has a predictable trajectory. As eGFR falls, decisions about dialysis, transplant or conservative care become unavoidable. ACP lets you make those decisions calmly, with family input, rather than in an emergency. Studies show ACP reduces unwanted hospital admissions and improves quality of life in the final year.

ReSPECT — your emergency care summary

A single-page NHS document that travels with you (paper or electronic). It records:

  • Your medical conditions and treatments
  • What matters most to you (comfort vs life-prolongation)
  • CPR preference (attempt or do-not-attempt)
  • Place of care wishes

Discuss with your GP, renal team or palliative care team. Review yearly or after major health changes.

Advance Decision to Refuse Treatment (ADRT)

An ADRT is the only legally binding way to refuse specific future treatments. For CKD patients it commonly covers:

  • Future dialysis
  • Mechanical ventilation
  • Artificial nutrition/hydration
  • CPR

Requirements:

  • Written, signed, dated
  • Witnessed signature
  • Must state 'I refuse this even if my life is at risk' for life-sustaining treatments
  • Can be changed or revoked anytime you have capacity

Free templates: Compassion in Dying, NHS or Macmillan.

Kidney Vitality is a daily multivitamin developed by a UK Consultant Nephrologist using renal nutrition principles. It contains no added potassium, magnesium, phosphorus or iron, and no herbal blends. See the formulation.

Lasting Power of Attorney (Health and Welfare)

Appoints someone to make health decisions on your behalf if you lose capacity. Crucially:

  • Different from Property and Financial LPA — most people set up both.
  • Cannot be used while you have capacity.
  • Can include explicit instructions about life-sustaining treatment.
  • £82 fee per LPA; fee waiver if on certain benefits or low income.
  • Apply at gov.uk/power-of-attorney.

Conservative care — the active alternative

Conservative (or 'comprehensive conservative') care is active management of advanced CKD WITHOUT dialysis. It is NOT 'doing nothing':

  • Symptom control (anaemia, fatigue, itching, fluid)
  • BP and diabetes management
  • Dietary support
  • Palliative care input
  • Psychological and spiritual support

For frail older patients with multiple comorbidities, conservative care often gives equivalent quality-of-life months to dialysis with fewer hospital admissions. Discuss openly — it is a valid, dignified choice.

Talking to family

ACP works best when family knows your wishes. Practical steps:

  • Tell at least one family member or close friend.
  • Give a copy of your ADRT and LPA to them and your GP.
  • Carry a wallet card noting where the documents are.
  • Revisit yearly — wishes can change.
Preparing for Dialysis
Related reading: Preparing for Dialysis.

Key practical tips

Designed for quick scanning — what to order, what to avoid, sensible portions, common mistakes.

  • Batch-cook two kidney-friendly meals on a quiet evening
  • Keep a shortlist of go-to snacks for tired days
  • Tell your renal team about any new symptom early

Clinical guidance

TL;DR summary

Advance care planning is for anyone with CKD, at any stage. The four key tools in the UK: ReSPECT form, Advance Decision to Refuse Treatment (ADRT), Lasting Power of Attorney (Health), and a Statement of Wishes. None of them shorten life — they ensure your voice is heard.

Key takeaways
  • ReSPECT form: records emergency care wishes incl. CPR.
  • ADRT: legally binding refusal of specific treatments.
  • LPA (Health): appoints decision-maker if you lose capacity.
  • Conservative care = active management without dialysis.
  • All paperwork is free except LPA (£82, waivers available).
Kidney Diet & Nutrition Considerations

Lifestyle and nutrition reinforce each other in kidney disease. Even small changes — cooking more meals at home, swapping ultra-processed snacks for whole-food alternatives, walking after meals — add up. The underlying pattern is the same Mediterranean-style, reduced-salt plate recommended across UK renal guidance.

Foods to prioritise

  • Home-cooked meals built around vegetables and whole grains
  • Lower-potassium fruit between meals
  • Hydration spread across the day (within your fluid allowance)
  • Movement most days — even a 20-minute walk

Foods to limit

  • Ultra-processed snacks and ready meals
  • Sugary and energy drinks
  • Salt at the table

Potassium, phosphate and protein needs vary between individuals — please confirm personal targets with your renal team or dietitian. Browse the Kidney Diet Hub for more guides in this cluster.

Frequently asked questions

What is advance care planning?

Advance care planning (ACP) is the process of thinking ahead about your future care if you become too unwell to decide for yourself. In CKD it commonly covers dialysis decisions, resuscitation preferences, place of care, and who can speak for you.

What is a ReSPECT form?

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a NHS form that records your wishes about emergency care including CPR. It is not legally binding but is followed by clinicians. Available through your GP or renal team.

What is an Advance Decision to Refuse Treatment (ADRT)?

An ADRT is a legally binding written statement refusing specific treatments (e.g. dialysis, ventilation, CPR) if you lose capacity. It must be signed, witnessed, and (for life-sustaining treatment refusal) explicitly state it applies even if life is at risk.

What is a Lasting Power of Attorney (LPA) for health?

An LPA for Health and Welfare lets you appoint someone to make health decisions on your behalf if you lose capacity. Registered through the Office of the Public Guardian (£82 fee, fee-waivers available). Different from a Welfare or Financial LPA.

What lifestyle changes help kidney disease?

The most evidence-based lifestyle changes for kidney disease are stopping smoking, keeping blood pressure and blood sugar in target, staying physically active most days, maintaining a healthy weight, drinking sensibly within UK low-risk limits, and eating a Mediterranean-style, reduced-salt diet.

Nutritional challenges in kidney disease

Many people living with kidney disease have to limit foods because of potassium, phosphate, diabetes, dialysis, appetite changes or simply the time it takes to cook from scratch every day. That can make it harder to keep daily nutrition balanced — particularly for vitamins and minerals that food alone may not fully cover.

Kidney Vitality is a UK-formulated daily nutritional support product designed by Consultant Nephrologist Professor Mohammed Mahdi Althaf with renal nutrition in mind from the start. It keeps doses moderate, leaves out added potassium, phosphate and magnesium, and avoids megadose vitamin A — sitting alongside a kidney-friendly diet, not replacing it.

Why Kidney Vitality fits this need

Built around UK renal guidance

Aligned with NICE NG203, Renal Association conservative care guidance and Resuscitation Council UK ReSPECT process.

Designed by a UK Consultant Nephrologist

Formulated and reviewed by Professor Mohammed Mahdi Althaf (GMC 7216325).

Evidence-based by design

Patient-first, non-judgemental, UK NHS pathways.

Designed by a UK Consultant Nephrologist

Ready to support your kidney health?

If you have been researching kidney health, supplements, CKD nutrition or kidney-friendly living, Kidney Vitality was developed specifically around those principles by Professor Mohammed Mahdi Althaf (GMC 7216325). Nephrologist Developed Daily Multivitamin.

  • No Added Potassium
  • No Added Magnesium
  • No Added Phosphorus
  • No Added Iron
  • One capsule daily
  • UK GMP — BRCGS, NSF GMP, Halal
Subscribe & Save — £20.39/monthCheck your current multivitamin

✓ Free UK tracked delivery  ·  ✓ Delivered every 30 days  ·  ✓ Pause or cancel anytime  ·  ✓ Never run out

ComparisonKidney VitalityTypical high-street multivitamin
Added potassiumNoneOften included
Added phosphateNoneOften included (E338–E452)
Vitamin A (retinol)No megadoseOften high-dose retinol
Kidney-focused formulationYesNo — general population
Consultant Nephrologist involvementYes (GMC 7216325)No
UK GMP manufacturedYes (BRCGS, NSF GMP)Varies

Food supplement. Not a medicine and not a treatment for kidney disease. Speak with your GP, pharmacist or renal team before starting any new supplement, especially in advanced CKD, on dialysis, post-transplant, pregnant or breastfeeding.

Clinical reviewer

Professor Mohammed Mahdi Althaf

Consultant Nephrologist

Acute Physician

GMC 7216325

View Full Biography

Professor Mohammed Mahdi Althaf is a UK Consultant Nephrologist and Acute Physician with a special interest in chronic kidney disease, AKI prevention and renal nutrition. He combines hospital practice with patient education and clinical guidance review.

View professional profile →
View Credentials
  • MD
  • MSc
  • PgDip (Clin Ed)
  • FRCP
  • FHEA
  • FASN

About this article

Written for UK patients and based on:

  • NICE guidance
  • NHS resources
  • British Dietetic Association guidance
  • Kidney Care UK resources
View methodology

Each article is researched against current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO and KDOQI international guidelines, and the British Dietetic Association Renal Nutrition Group. Drafts are written by the Kidney Vitality editorial team and reviewed by a UK Consultant Nephrologist before publication. Content is reviewed on a rolling basis and updated when guidance changes.

Editorial standards

  • Clinically reviewed
  • NHS-aligned
  • NICE-aligned
  • Evidence-based
  • Reviewed before publication
View full editorial process

Every article is researched and written by the Kidney Vitality editorial team using current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO/KDOQI international guidelines, and British Dietetic Association renal nutrition guidance. Drafts are reviewed for clinical accuracy by Professor Mohammed Mahdi Althaf, MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN (Consultant Nephrologist & Acute Physician, GMC 7216325) before publication. Content is updated when UK guidance changes.

References (4)View Sources
  1. NICE NG203: Chronic kidney disease — assessment and management
  2. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD
  3. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update
  4. British Dietetic Association — Renal Nutrition Group

Medical disclaimer

This content is educational only and does not replace personalised medical advice.

Read full disclaimer

This page is general information, not personal medical advice. If you have chronic kidney disease, are on dialysis, have had a kidney transplant, are pregnant or breastfeeding, or take prescription medication, please confirm any supplement with your GP, pharmacist or renal team before starting.

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