Patients with end-stage kidney disease have significantly increased morbidity and mortality. While greater attention has been focused on advanced care planning, end-of-life decisions, conservative therapy and withdrawal from dialysis these must be supported by adequate palliative care incorporating symptom control. With the increase in the elderly, with their inherent comorbidities, accepted onto dialysis, patients, their nephrologists, families and multidisciplinary teams, are often faced with end-of-life decisions and the provision of palliative care. While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well-informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence-based guidelines, core curricula, position statements, standards and tools in palliative care in end-stage kidney disease.

Item Type:	Refereed Article
Keywords:	conservative therapy, kidney failure, morbidity, mortality, palliative care
Research Division:	Biomedical and Clinical Sciences
Research Group:	Clinical sciences
Research Field:	Nephrology and urology
Objective Division:	Health
Objective Group:	Provision of health and support services
Objective Field:	Palliative care
UTAS Author:	Robertson, IK (Dr Iain Robertson)
UTAS Author:	Youl, L (Ms Loren Taylor)
UTAS Author:	Bull, R (Professor Rosalind Bull)
ID Code:	71730
Year Published:	2011
Funding Support:	National Health and Medical Research Council (512809)
Web of Science® Times Cited:	59
Deposited By:	Health Sciences A
Deposited On:	2011-08-03
Last Modified:	2018-03-29
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