Comprehensive Insights into Palliative Nephrology: A Chapter in Contemporary Renal Medicine

Abstract

Chronic Kidney disease (CKD) is a global epidemic, affecting more than 800 million people worldwide. Advanced CKD patients experience a substantial symptom burden, compromising their Health-Related Quality of Life. It is crucial for healthcare practitioners to understand the palliative needs of CKD patients, and participate in Advance Care Planning (ACP) and shared decision-making, aligning medical care with patients’ preferences and values. Prognostication tools can help identify those unsuitable for dialysis, leading to consideration of conservative kidney management (CKM), prioritizing supportive care over invasive interventions. Early palliative care referral improves symptom control, patient satisfaction, and goal-concordant care. Symptom management is an important consideration and requires careful consideration of drug dosing and toxicities due to impaired renal function. Dialysis, while extending life, may exacerbate patient suffering; optimizing comfort-oriented therapy can enhance quality of life. End-of-life care, including dialysis withdrawal and hospice care, is a key feature of palliative nephrology, but ethical dilemmas and cultural context must be carefully considered. With an aging CKD population, nephrologists will need to integrate palliative care principles into routine kidney care. This will include improving confidence and competence in providing palliative renal care, and implementing system-level changes to remove barriers to effective palliation and end-of-life care.