This chapter addresses three main topics (subchapters): (i) acquisition of educational skills in palliative care that are relevant to all health professionals and ways to implement these skills in the field of nephrology; (ii) ethical considerations that are applicable and support clinical and specific decisions at different stages of chronic kidney disease, such as, respect for bioethical principles in decision making related to dialysis withdrawal, effective communication with the patient and family, end of life care; and (iii) implementation and definition of key performance indicators that ensure quality of care and are patient-centred. These three (interrelated) pillars will strongly contribute to the (positive and expected) changes in the field of kidney palliative care.