Palliative Care in End-Stage Renal Disease

Patients with end-stage renal disease (ESRD) often experience a multitude of physical and psychosocial symptoms. The life expectancy of patients on dialysis is approximately 20% of that of age-matched individuals without renal disease. Of note, uremic calciphylaxis (or calcific uremic arteriopathy) can cause painful skin lesions and portends a poor prognosis. Frequent assessments, early intervention, and involvement of the interdisciplinary team are key to providing care for these patients. Decision-making for the initiation and withdrawal of dialysis is a complicated process. The prognosis after withdrawal of dialysis is usually short, and symptoms associated with uremia such as seizures and nausea should be treated promptly. This chapter discusses the key issues related to ESRD, including symptom management and end-of-life discussion.