Palliative and End-of-Life Care in Nephrology

Moving From Observations to Interventions

Nwamaka D. Eneanya; Michael K. Paasche-Orlow; Angelo Volandes


Curr Opin Nephrol Hypertens. 2017;26(4):327-334. 

In This Article

Abstract and Introduction


Purpose of review In comparison with patients who have other serious illnesses, patients with advanced kidney disease have a higher rate of intensive care utilization at the end of life and receive palliative care less frequently. Consensus and clinical practice guidelines have therefore recommended the incorporation of palliative care earlier in the disease trajectory. This review summarizes recent literature on this aspect of care and will highlight future directions for patient-centered care within palliative nephrology.

Recent findings Patients with advanced kidney disease and their families frequently do not engage effectively with their clinicians to make informed treatment decisions or plan for care at the end of life. Furthermore, racial and ethnic minority patients continue to receive a lower rate of palliative care services compared to other racial groups. Interventions that promote better palliative care communication and education among nephrology clinicians, patients and their families are becoming increasingly more common in nephrology.

Summary Overall, improved understanding of the unique care needs of patients with advanced and end-stage kidney disease provides a solid foundation to improve palliative and end-of-life care delivery among diverse populations in nephrology.


The WHO defines palliative care as comprehensive care that improves quality of life for patients and their families who are facing problems associated with life-threatening illnesses.[1] Specifically, for patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), palliative care offers a support framework that can address distressing physical and emotional symptoms as well as complex treatment decision-making.[2–4] Despite ambiguity about the benefit of dialysis therapies for certain patients with ESRD, evidence-based models to aid clinicians, patients and their families in discussing prognosis and engaging in shared decision-making regarding dialysis are lacking.[3,5] Dialysis may not extend survival for frail or older patients with multiple comorbidities and can negatively impact quality of life and functional status.[6–9] Conservative kidney management (CKM), which encompasses nondialytic therapy for volume control, anemia, blood pressure, electrolyte/acid-base abnormalities and physical symptoms, may be a reasonable option for patients who may not benefit from dialysis therapies.[10] An early palliative care approach can address decision-making, several aspects of CKM and care at the end of life including advance care planning, hospice use and bereavement support.[11] Also, as patients with CKD and ESRD from minority racial-ethnic groups use palliative care resources less often than other racial groups, interventions that consider various differences in knowledge and communication styles may be key in reducing health disparities and improving equal access to effective end-of-life (EOL) care.[12–14]