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End stage kidney disease - palliative peritoneal dialysis programs: narrative review
Atthaphong Phongphithakchai1, Phongsak Dandecha1, Sukit Raksasuk2
1Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
BMJ Supportive & Palliative Care
|September 8, 2025
Summary
Palliative peritoneal dialysis (PD) offers a patient-centered approach for end-stage kidney disease (ESKD) patients, enhancing comfort and autonomy. This integrated care model prioritizes symptom management and shared decision-making for improved quality of life.
Area of Science:
- Nephrology
- Palliative Care
- Geriatrics
Background:
- End-stage kidney disease (ESKD) affects a growing elderly population with comorbidities, increasing cancer risk and socioeconomic burden.
- Integrated care, including palliative care, is crucial for managing complex ESKD cases.
- Palliative peritoneal dialysis (PD) aims to improve comfort, quality of life, and autonomy for patients with ESKD.
Purpose of the Study:
- To guide the development of palliative PD programs for end-stage renal disease patients.
- To synthesize current knowledge on integrating palliative care with PD.
Main Methods:
- A comprehensive literature review focused on palliative care integration in dialysis, with a specific emphasis on PD.
- Synthesis of evidence from 37 references covering rationale, infrastructure, protocols, outcomes, implementation, challenges, and benefits of palliative PD.
Main Results:
- Palliative PD promotes patient-centered care through flexible scheduling and reduced physical strain compared to in-center dialysis.
- Key elements include shared decision-making, effective symptom control, and upholding patient autonomy.
- Successful implementation necessitates healthcare provider training and robust multidisciplinary collaboration.
Conclusions:
- Palliative PD signifies a paradigm shift in advanced kidney disease management.
- It underscores the critical importance of symptom relief, psychological support, and patient empowerment.
- This approach enhances the overall well-being of patients with ESKD.
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