For those who are not able to receive dialysis treatment, non dialytic management of ESRD seems to be a viable option. Patients managed conservatively had reported high symptom burden underscoring the need for concurrent palliative care[64]. Hence, physicians are now considering palliative care services that specialize in symptom management for ESRD patients[62,63]. This is especially important in frail, illiterate, elderly multi-morbid patients with limited physical activity, where prognosis may not be altered by dialytic therapy. In such scenarios, palliative care will help improve quality of life.