Palliative and end-of-life care issues in chronic kidney disease

Area of Science:

• Nephrology
• Palliative Care
• Cardiology

Background:

• Progressive chronic kidney disease (CKD) is associated with significant morbidity, mortality, and symptom burden.
• Cardiovascular disease (CVD) and congestive heart failure (CHF) are common comorbidities that exacerbate these burdens in CKD patients.
• Palliative and end-of-life care considerations are crucial for managing progressive CKD.

Purpose of the Study:

• To review recent literature on palliative and end-of-life care for patients with progressive CKD.
• To highlight specific issues for CKD patients with coexisting CVD and CHF.
• To inform recommendations for optimal patient care.

Main Methods:

• Literature review of recent studies.
• Synthesis of findings related to palliative and end-of-life care in progressive CKD.
• Focus on patient populations with CVD and CHF.

Main Results:

• Dialysis may not benefit older, frail CKD patients, particularly those with comorbidities.
• Conservative management (without dialysis) can lead to comparable survival to dialysis initiation.
• Conservative management may preserve function, improve quality of life, and reduce acute care admissions compared to dialysis.

Conclusions:

• A palliative approach is essential for quality care in many patients with progressive CKD.
• Conservative management should be considered and offered to appropriate patients, especially the elderly and frail with comorbidities.
• Individualized decision-making regarding dialysis initiation is critical, considering patient goals and functional status.