Supportive and palliative care for the patient with end-stage renal disease

As the numbers of patients presenting with end-stage renal disease (ESRD) increases, more are opting to withdraw from dialysis, often due to increased suffering and poor prognosis related to other comorbidities. Concurrently, other renal patients are deciding to forgo dialysis, recognizing that the burden of frequent dialysis may outweigh likely survival and quality-of-life benefits. Renal nursing is concerned with the health needs of individuals and their carers who are experiencing a progressive decline in renal function or who have lost renal function completely, and there is a focus on the provision of renal replacement therapy such as haemodialysis. As more patients decide to withdraw from, or not to embark on, dialysis, an enhanced approach to assessment and control of symptoms, as well as supportive management is required, including effective and high-quality palliative care. There is a necessity for renal nurses to change from disease management through interventions of a physiological nature to that of providing support and symptom management. This article discusses the supportive and palliative nursing care needs of a population largely unheard in the literature - patients with ESRD - and highlights the need for further patient and carer-centred research in this area.