Deciding who is that “right patient” is a decision that is best left to the discussion between the patient and their nephrologist. Traditionally, when patients were not deemed to be candidates for dialysis, nephrologists would say, “we are going to withhold dialysis on Ms. X”. However, saying “withhold” has negative connotations (think “we are going to withhold life support, etc etc”). To a typical patient and their family, it gives the impression that the doctor is not going to be offering anything and we basically wait till the patient dies. However, this couldn’t be further from the truth since a lot of complications of kidney disease can and should be managed with medicines.
In other words, nephrologists could still offer a lot; pretty much everything short of hooking up the patient to the dialysis machine. And hence, to better communicate what is still do-able for the patient, the appropriate term for non-dialytic management of kidney failure that is now used is Maximal Conservative Management (MCM).