Supportive care in advanced kidney disease: patient attitudes and expectations

Treatment with dialysis has benefitted large numbers of patients with advanced kidney disease. It is though highly intrusive and demanding and some elderly, frail patients may tolerate it poorly. Some of these patients who are either approaching 'end-stage' kidney disease or 'failing' despite being on dialysis may choose to pursue supportive or palliative approaches, partially or fully replacing the dialysis option. Here, we describe some of the challenges confronting these patients and present data on the attitudes and perceptions to supportive care and end-of-life care planning of patients on haemodialysis including some whose prognosis was poor. The main focus for these patients appeared to be on holding on to what they had, adapting by living 'from day to day' in the present, and continuing to hope for the best. Advance care planning was seen as potentially useful by patients, once clarity surrounding its purpose had been established.