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Advanced kidney disease: care of the dying

  1. Is the care of the patient and family in the last hours and days of life. It incorporates four key domains of care, physical, psychological, social and spiritual and supports the family at that time and into bereavement.

    Conservative kidney management
    Full supportive treatment for those with advanced kidney failure who, in conjunction with carers and the clinical team, decide against starting dialysis.

    Palliative dialysis
    Dialysis tailored to align with the supportive needs of a person “deteriorating despite dialysis” and mainly aimed at preventing or treating symptoms such as those related to fluid overload. It may involve reduced duration and frequency of sessions.

    Dialysis withdrawal in advanced kidney disease
    Cessation of dialysis treatment usually in someone “deteriorating despite dialysis” with evident need for end of life care, the decision usually being made by the patient in conjunction with carers and clinical teams. The requirement for supportive and palliative care during the phase of end of life care often precedes dialysis withdrawal by many months or years, resulting in end of life care needs being under recognised and not addressed in a timely manner.

    See also: advancer kidney disease

    Reference: O’Donoghue D, Richards M. end of life care in advanced kidney disease: a framework for implementation. NHS Kidney Care National End of Life Care Progamme. June 2009. Internet. Accessed December 22, 2010. Available at: http://www.endoflifecareforadults.nhs.uk/assets/downloads/EndofLifeCareAKD.pdf.