Background Share decision-making and advance care planning (ACP) is essential for patients with end-stage renal disease (ESRD). Karunrak Palliative Care Center started a Renal Palliative Care Program in 2017, which is the first joint Chronic kidney disease-Palliative care program in Thailand. ESRD patients always received discordant end-of-life care (EOLC).

Methods The causes of the discordance of EOLC of conservative kidney management (CKM) patients who died during the period of October 1, 2020 to September 30, 2022 were retrospectively reviewed.

Results The demographic data of 38 deceased CKM patients were: 78.9% aged ≥75; 55.3% Charlson comorbidity index ≥8, 89.5%; Karnofsky Performance status > 40%. Median survival time after entered the program was 409.0 days, IQR= 184.5–602.5 days and 42.1% is greater than 12 months. All patients had ACP documentation, but only 15.8% had advance directive.

Conclusion The causes of discordance between ACP preferences and actual EOLC received majority are from severe symptoms especially dyspnea. Other serious illnesses which led to hospitalization in this report are COVID-19 infection and stroke.