End-stage kidney disease: The last 12 months.

Abstract

Chronic kidney disease (CKD) is increasingly prevalent in Australia's ageing population. Over the past decade, there has been growing recognition that dialysis does not benefit every patient with end-stage kidney disease (ESKD). Patients with advanced age, significant comorbidities and poor functional status may not gain a survival benefit with dialysis when compared with being managed conservatively. These developments have implications forgeneral practitioners (GPs). A further development has been the emergence ofrenal supportive care, a patient-centred approach that integrates the principles of palliative care into nephrology. The aim of this article is to outline salient aspects in the care of patients with ESKD. Salient aspects throughout the trajectory of ESKD are discussed, including symptoms of CKD, relevant management, prognostication, advance care planning discussions and end-of-life care. The role of the GP is vital, and it is recommended that GPs are involved early in a patient's CKD trajectory.