Palliative care in end-stage kidney disease

Area of Science:

• Nephrology
• Palliative Care
• Geriatrics

Background:

• End-stage kidney disease (ESKD) is associated with high morbidity and mortality, particularly in an aging population.
• Increasing numbers of elderly patients with comorbidities are initiating dialysis, complicating end-of-life decision-making.
• Palliative care and symptom control are essential components of care for ESKD patients facing end-of-life decisions.

Purpose of the Study:

• To review and summarize evidence-based guidelines, standards, and tools for palliative care in end-stage kidney disease.
• To highlight the importance of informed patient choice between dialysis and conservative management.
• To emphasize the necessity of palliative care support for all treatment pathways in ESKD.

Main Methods:

• Systematic review of published studies, evidence-based guidelines, core curricula, position statements, and standards.
• Analysis of observational studies and existing literature due to a lack of randomized controlled trials.
• Synthesis of information on palliative care interventions and decision-making support for ESKD patients.

Main Results:

• Limited evidence from randomized controlled trials exists; guidance primarily comes from observational studies.
• Predicting poor outcomes for dialysis patients remains challenging.
• Shared decision-making regarding treatment options (dialysis vs. conservative) and the role of palliative care is critical.

Conclusions:

• Palliative care and symptom management are vital for all end-stage kidney disease patients, irrespective of their chosen treatment path.
• Patients must be thoroughly informed about all treatment options, including conservative management and withdrawal from dialysis.
• Clear treatment pathways and robust palliative care support are essential for improving the quality of life and decision-making process for ESKD patients and their families.