Palliative Care in Kidney Disease

Patients with kidney disease may need palliative or supportive care. Although care should be based on needs and not on prognosis, it is nevertheless important to consider palliative needs in the context of the number of weeks, months, or years that remain. The issues that need to be addressed only weeks from death are often very different—and more urgent—than those to be addressed if there are years ahead. A comprehensive overview of evidence on survival allows the context of care to be understood. A detailed examination of how to identify and manage common symptoms is essential, although details of management may vary from country to country, according to local guidelines and the availability of individual medicines. Pain, constipation, breathlessness, nausea, vomiting, itch, restless legs, and fatigue are all symptoms that may be encountered. The last days of life may sometimes prove challenging in terms of symptom management, yet it is important to provide best possible care at this time. Teamwork, communication, and planning ahead are all crucial for effective and coordinated care, helping to facilitate the best palliative and supportive care for this population.