Palliative Care in Advanced Kidney Disease: The Approach for a Nephrologist

Abstract

ABSTRACT Advanced kidney disease presents a significant burden to patients, often leading to a complex array of symptoms and challenges that impact their quality of life. Palliative care (PC), with its focus on symptom management, communication, and holistic support, plays a crucial role in enhancing the well-being of these patients. This article explores the principles of PC in the context of advanced kidney disease, highlighting the need for early integration into standard nephrology care. It also discusses PC interventions such as symptom management, psychosocial support, advanced care planning (ACP), withdrawal of dialysis, and end-of-life care. Symptom management is an essential aspect of kidney-supportive care. The psychosocial burden of advanced kidney disease on the patient and the family needs to be adequately explored along with optimum utilization of local and institutional resources. The option of withdrawal of dialysis should be considered and discussed with patients where applicable. The Supreme Court has laid down guidelines for ACP which include both medical and legal processes to be followed. End of life is a sentinel event that needs adequate medical and nursing support which should be offered keeping in mind the principle of nonabandonment.