We describe a case of nephrotic syndrome case who defaulted treatment but presented with acute medical complication due to non-compliance to treatment. He subsequently developed neurological sequalae following definitive hemodialysis. Due to disease severity and its complication, active dialysis has been abandoned. There are many factors leading to this decision, but are palliative care physician right to follow the primary team’s decision, in palliating a patient with chronic kidney disease with potential hyperkalaemia consequences? The article focuses on potential ethical dilemma faced by the palliative care team in the subsequent management of this scenario.