Palliative care: misconceptions that limit access for patients with chronic renal disease

There is an urgent need to incorporate palliative care into the treatment of patients with end-stage renal disease (ESRD). These patients have a shortened lifespan and face end-of-life decisions as renal function declines and renal replacement therapy becomes necessary. They also experience a high symptom burden as a result of the illness as well as its treatment. Why, then, do patients with ESRD rarely receive expert palliative care services that have been shown to enhance the quality of life of patients with other life-limiting illnesses? The lack of access to palliative care can be attributed, in part, to misconceptions about its philosophy and goals. It is hoped that clarification of these misconceptions will facilitate integration of palliative care into routine nephrology practice.