Resources for planning palliative and end-of-life care for patients with kidney disease

Historically, Americans have died of infectious diseases, often in childhood or young adulthood. Cancer has also been responsible for thousands of deaths. With the advent of improved antibiotics and chemotherapy, people are surviving much longer and many, especially those over 65 years of age, will incur at least one chronic disease or disability in their lifetime. As the health care emphasis has changed from intervening for acute illness to treating the adverse effects of chronic disease, our health care system has also somewhat shifted gears. Unlike serious acute illness, chronic illness generally does not lead to a swift death in a hospital, but rather to a prolonged course of symptom management in the home setting or a long-term care facility. In some situations, the patient or family are battling a disease process where death is inevitable. Although holding on for a cure, the patient and family may begin considering the option of a dignified and peaceful death. In the care of renal patients, nephrology nurses have an expanded and important role in assisting patients with their decisions concerning palliative and end of life care and in providing that care. Fortunately, resources are now available to assist with the coordination of a therapeutic plan of care.