Integrating palliative care into routine nephrology practice

Integrating palliative care principles into clinical practice in nephrology has become an urgent need with the growing number of patients with advanced age and frailty reaching end-stage kidney disease (ESKD). While principles of palliative care are increasingly recognized and endorsed by major guidelines, practical implementation remains insufficient. This narrative review synthesizes current evidence on practical approaches to palliative care in frail and elderly patients with ESKD. The scope of this review includes prognostication, discussing goals of care, evaluating conservative kidney management (CKM) as a treatment option, individualizing dialysis prescription and access planning, medication deprescribing and dialysis withdrawal. We argue that nephrologists can incorporate low-threshold tools into their practice even without specialist palliative care training. Integrating these principles can reduce unnecessary interventions, improve symptom management, and deliver care adapted to patients' goals.