Kidney Supportive Care

Patients with kidney disease are increasingly older and have significant medical complexity. Older adults with multiple co-morbidities such as chronic kidney disease (CKD) experience high symptom burden and often undergo aggressive medical interventions at the end of their life with low utilization of hospice services. Kidney supportive care is specialized palliative care for patients with kidney disease. It aims to improve the experience of living with kidney disease by optimizing the quality of life of patients and their families and preventing and relieving suffering. The main domains of kidney supportive care include: (1) estimation of prognosis to identify patients who would most benefit from kidney supportive care, (2) assistance with advanced care planning with shared decision making to promote goal-coordinate care, (3) education on the option of comprehensive conservative care, (4) coordination with dialysis transitions such as a time-limited trial of dialysis, palliative dialysis, and withdrawal from dialysis, (5) symptom assessment and management, and (6) end of life care. It is important for all providers taking care of patients with kidney disease, including nephrologists, primary care physicians, advanced care providers, nurses, and social workers to have primary palliative care skills to implement kidney supportive care. The following chapter focuses on essential primary palliative care skills in the unique context and challenges of kidney disease.