End-stage kidney disease The last 12 months

Abstract

BackgroundChronic kidney disease (CKD) isincreasingly prevalent in Australia’sageing population. Over the past decade,there has been growing recognition thatdialysis does not benefit every patientwith end-stage kidney disease (ESKD).Patients with advanced age, significantcomorbidities and poor functional statusmay not gain a survival benefit withdialysis when compared with beingmanaged conservatively. Thesedevelopments have implicationsfor general practitioners (GPs). A furtherdevelopment has been the emergenceof renal supportive care, a patient-centredapproach that integrates the principles ofpalliative care into nephrology.ObjectiveThe aim of this article is to outline salientaspects in the care of patients with ESKD.DiscussionSalient aspects throughout the trajectoryof ESKD are discussed, includingsymptoms of CKD, relevant management,prognostication, advance care planningdiscussions and end-of-life care. The roleof the GP is vital, and it is recommendedthat GPs are involved early in a patient’sCKD trajectory