Nephrology

An increasingly older End-Stage Renal Disease (ESRD) population requires nephrologists to focus on issues relating to palliative care. The Renal Physicians Association (RPA), for example, sponsored an evidence-based guideline relating to withholding and withdrawing from dialysis, and the United Kingdom Expert Consensus Group published guidelines for symptom management in adults dying with Chronic Kidney Disease (CKD). Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a workgroup on the topic of palliative or supportive care in CKD outlining the need for additional study and the initiation of palliative treatments. Since nearly 20% of dialysis patients stop dialysis before death and increasingly, older patients are choosing not to begin dialysis in part due to poor outcomes and decreasing functional status with dialysis, it is likely that all nephrologists will be involved in end-of-life care of ESRD and CKD patients. As a group, however, physicians are poorly trained in palliative care and often feel uncomfortable with the responsibility of dying patients. In one survey of American and Canadian physicians, for example, only approximately 40% of 360 nephrologists stated that they were very well prepared to make end-of-life decisions. Despite the identification of the importance of palliative care in ESRD care, nephrology fellows remain uncomfortable and poorly trained in these aspects of clinical care. The primary aim of this talk is to highlight the importance of this critical point and make nephrologists more aware and more familiar with dealing with such a problematic and essential topic.