Epidemiology of renal palliative care.

The need for palliative care for patients with end-stage renal disease (ESRD) is increasingly recognized. Patients starting renal replacement therapy are now elderly, with a median age of 65 years, and with multiple comorbid conditions. Quality of life is often poor and with advance care planning, patients can be enabled to make the choice of stopping or not starting dialysis. With planned end-of-life management patients can then choose their place of death. These discussions have to be initiated by the renal team. The involvement of palliative care professionals in patients with ESRD is therefore both educational and the provision of community and hospice care.