End of life care in end-stage kidney disease

Abstract

There is a rise in burden of end-stage renal disease globally and in India. The symptom burden, prognosis, and mortality in chronic kidney disease closely mimics that of cancer. However, the palliative and end of life care needs of these patients are seldom addressed. A consensus opinion statement was developed outlining the provision of end of life care in end-stage kidney disease. Recognition of medical futility, consensus on medical futility, and cessation of potentially inappropriate therapies and medications are the initial steps in providing end of life care. Conducting a family meeting, communicating prognosis, discussing various treatment modalities, negotiating goals of care, shared decision-making, and discussion and documentation of life sustaining treatment are essential aspects of end of life care provision. The provision of end of life care entails assessment and the management of end-stage kidney disease symptoms and the care extends beyond the death of the patient to their families in the bereavement period.