If my kidneys are failing, do I have to have dialysis?

Not always. For advanced kidney disease there are broadly two paths: dialysis (or, for some, a kidney transplant), and conservative kidney management — also called kidney supportive care — which actively manages symptoms and slows decline without dialysis. For some people, especially those who are older or have other serious illnesses, conservative care can offer similar length of life with fewer hospital visits and better quality of life; for others, dialysis is clearly the right choice. It's a deeply personal decision that weighs how each option fits your health, your priorities and your life — made with your kidney specialist and GP.

What is conservative (non-dialysis) kidney care, exactly?

Conservative kidney management is active treatment, not 'doing nothing.' It focuses on controlling symptoms, managing blood pressure, diet, anaemia and other complications, protecting remaining kidney function, and supporting quality of life — without starting dialysis. It often involves a kidney team, your GP, and sometimes palliative-care input for symptom support. It's a legitimate, planned choice, and for some people it's the one that best matches what they want from their care. The right fit depends on your individual situation and is discussed with your renal team.

Is bladder leakage just part of getting older that I have to accept?

No. Incontinence is very common, but common is not the same as untreatable — and most people improve with the right approach. There's a real ladder of options: pelvic-floor muscle exercises and bladder training, lifestyle changes (like managing weight, fluids and constipation), medicines for some types, and surgery for selected cases. The best treatment depends on the type of incontinence you have (stress, urge, mixed or other), so the first step is having it properly assessed rather than putting up with it.

What are the main treatment options for incontinence?

It depends on the type. For stress incontinence (leaking with coughing, laughing or exercise), pelvic-floor muscle training is usually first-line, with surgery an option for some. For urge incontinence (a sudden strong need to go), bladder training, lifestyle measures and certain medicines are common. Many people have a mix. Conservative measures like pelvic-floor exercises and bladder training help a great many people and carry little downside, which is why they're usually tried first. A continence physiotherapist or nurse can tailor a plan, and the National Continence Helpline (1800 33 00 66) is a free starting point.

Who should I see about these decisions?

Your GP is the right place to start for both. For advanced kidney disease, your GP works alongside a kidney specialist (nephrologist) and renal nurses, and the dialysis-versus-conservative decision is made with that team. For incontinence, your GP can assess the type, start first-line measures, and refer you to a continence physiotherapist, continence nurse or specialist if needed. Bringing prepared questions makes these appointments far more useful.

Decision aid

Kidney and bladder decisions — dialysis and incontinence

By Dr HB Lo, FACRRM Reviewed 15 June 2026 4 min read

General information to help you prepare for your GP — not a diagnosis, not personal medical advice. It doesn't replace a consultation, and using it doesn't create a doctor–patient relationship.

Two very different parts of the body, two decisions people often face quietly: what to do when kidneys are failing, and what to do about bladder leakage. Both are more of a menu than a single answer.

For advanced kidney disease, the big fork is dialysis versus conservative (non-dialysis) kidney care — a real choice that weighs how long and how well. For incontinence, there's a genuine ladder of treatments, from pelvic-floor and bladder training to medicines and surgery — and most people improve.

This guide explains how each decision is weighed so you can take clear questions to your GP. It's general information, not personal advice, and never tells you to change a medicine.

Two quiet decisions, both more open than they seem

Some health decisions get talked about a lot; others are carried quietly. Two of the quietest are what to do when kidneys are failing, and what to do about bladder leakage. People often assume the first means “you just have to go on dialysis” and the second means “you just have to live with it.” Both assumptions are wrong, and both decisions open up considerably once the real options are laid out.

This guide walks through both so you can take clear questions to your GP. None of it is personal advice, and none of it tells you to start, stop or change a medicine.

Advanced kidney disease: dialysis or conservative care

When chronic kidney disease reaches its advanced stages — kidney failure — there are broadly two paths. One is dialysis (and, for some people, a kidney transplant), which takes over the kidneys’ filtering job, as HealthDirect and Kidney Health Australia describe. The other is conservative kidney management, sometimes called kidney supportive care.

Conservative care is often misunderstood as “doing nothing.” It’s the opposite: it’s active treatment that manages symptoms, blood pressure, diet, anaemia and other complications, protects the kidney function you still have, and supports quality of life — without starting dialysis. For some people, particularly those who are older or living with other serious illnesses, this path can offer a similar length of life with fewer hospital visits and a better day-to-day quality of life; for others, dialysis is clearly the better choice. The honest framing isn’t only “how long” but “how long and how well.” The dialysis-versus-conservative decision aid below helps you weigh that, and prepare the conversation with your nephrologist and GP. There’s no universally right answer — it’s one of the most personal decisions in medicine, and it deserves time.

Incontinence: a ladder, not a life sentence

Bladder leakage is extremely common, and far too often quietly accepted as just part of ageing. But common is not the same as untreatable — and most people improve with the right approach, as the Continence Foundation of Australia and HealthDirect make clear.

There’s a real ladder of options, and the right rung depends on the type of incontinence:

Conservative measures first. Pelvic-floor muscle exercises and bladder training help a great many people and carry little downside — which is exactly why they’re usually tried first. Lifestyle changes (managing weight, fluids and constipation) help too.
Medicines have a role for some types, particularly urge incontinence.
Surgery is an option for selected people, more often with stress incontinence.

Because the best treatment depends on whether you have stress, urge or mixed incontinence, the first real step is having it properly assessed rather than putting up with it. The incontinence treatment decision aid below helps you describe what’s happening in the words a clinician needs, and sort which options fit. A free starting point is the National Continence Helpline on 1800 33 00 66, staffed by continence nurses.

Where to start

For both, your GP is the right first stop, working alongside the relevant team — a kidney specialist for advanced kidney disease, or a continence physiotherapist or nurse for bladder problems. The broader picture of how the kidneys work and what threatens them is well covered by Kidney Health Australia, and your GP can help you make sense of where you sit.

The questions worth taking in

For my kidney health and my priorities, what would dialysis and conservative care each look like for me?
If I chose conservative care, how would my symptoms and quality of life be supported?
What type of incontinence do I have, and what’s the first-line treatment for it?
Can you refer me to a continence physiotherapist or nurse, and what can I start now?

These are questions, not conclusions. The aim is to decide with your GP and the specialist team, with the options laid out honestly.

What this is, and is not

This is general information to help you prepare for your GP — not a diagnosis, and not personal medical advice. It doesn’t tell you which kidney path to take or which incontinence treatment to choose, or to start, stop or change any medicine; those decisions are made with your own doctors. For trustworthy Australian background, see Kidney Health Australia and the Continence Foundation of Australia.

Related on this site: the chronic kidney disease explainer covers the kidney side in more depth, and the pelvic floor, prolapse and incontinence explainer goes deeper on the bladder side.

If you want a thorough, unhurried discussion of your own kidney or bladder picture, you can work with Dr Lo.

Author: Dr Hoe Bing Lo — AHPRA MED0001212640 · FACRRM. Fun Doctors Pty Ltd · ABN 83 404 436 330.

Tools to take to your GP

Each runs in your browser — nothing you enter is stored or sent anywhere. They help you prepare the questions and print a one-page summary to bring to your appointment. They don't diagnose or recommend a specific treatment.

Frequently asked questions

If my kidneys are failing, do I have to have dialysis?

Not always. For advanced kidney disease there are broadly two paths: dialysis (or, for some, a kidney transplant), and conservative kidney management — also called kidney supportive care — which actively manages symptoms and slows decline without dialysis. For some people, especially those who are older or have other serious illnesses, conservative care can offer similar length of life with fewer hospital visits and better quality of life; for others, dialysis is clearly the right choice. It's a deeply personal decision that weighs how each option fits your health, your priorities and your life — made with your kidney specialist and GP.
What is conservative (non-dialysis) kidney care, exactly?

Conservative kidney management is active treatment, not 'doing nothing.' It focuses on controlling symptoms, managing blood pressure, diet, anaemia and other complications, protecting remaining kidney function, and supporting quality of life — without starting dialysis. It often involves a kidney team, your GP, and sometimes palliative-care input for symptom support. It's a legitimate, planned choice, and for some people it's the one that best matches what they want from their care. The right fit depends on your individual situation and is discussed with your renal team.
Is bladder leakage just part of getting older that I have to accept?

No. Incontinence is very common, but common is not the same as untreatable — and most people improve with the right approach. There's a real ladder of options: pelvic-floor muscle exercises and bladder training, lifestyle changes (like managing weight, fluids and constipation), medicines for some types, and surgery for selected cases. The best treatment depends on the type of incontinence you have (stress, urge, mixed or other), so the first step is having it properly assessed rather than putting up with it.
What are the main treatment options for incontinence?

It depends on the type. For stress incontinence (leaking with coughing, laughing or exercise), pelvic-floor muscle training is usually first-line, with surgery an option for some. For urge incontinence (a sudden strong need to go), bladder training, lifestyle measures and certain medicines are common. Many people have a mix. Conservative measures like pelvic-floor exercises and bladder training help a great many people and carry little downside, which is why they're usually tried first. A continence physiotherapist or nurse can tailor a plan, and the National Continence Helpline (1800 33 00 66) is a free starting point.
Who should I see about these decisions?

Your GP is the right place to start for both. For advanced kidney disease, your GP works alongside a kidney specialist (nephrologist) and renal nurses, and the dialysis-versus-conservative decision is made with that team. For incontinence, your GP can assess the type, start first-line measures, and refer you to a continence physiotherapist, continence nurse or specialist if needed. Bringing prepared questions makes these appointments far more useful.

Source quality

Sources grouped by evidence tier. Australian primary tier first; international where Australia is silent or lagging. How tiers work.

T1 AU primary 9 sources

If you want a thorough, unhurried work-up of your own — not a generic answer — you can work with Dr Lo.