A new clinical practice guideline on initiation and withdrawal of dialysis that makes explicit the role of palliative medicine.

More than 50,000 long-term dialysis patients die per year, with roughly 20% of these deaths after a decision to stop dialysis. After dialysis discontinuation, the average dialysis patient lives for only 8 to 12 days. The renal community recognizes and recommends a role for palliative care in the end-of-life treatment of these patients. This article describes the new clinical practice guideline developed by the renal community, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, that makes explicit the role of palliative medicine in the treatment of dialysis-dependent patients who stop this treatment with the expectation that death will follow shortly.