Conservative and Palliative Care in Old Age Individuals with End-Stage Renal Disease

Abstract

In developed countries, trends in adjusted end-stage renal disease incidence rate are displaying a rising trend, particularly in the older age group. These trends pose major challenges to healthcare systems, given the greater healthcare utilization by and more comorbid conditions among elderly adults. Older patients with kidney disease face both a shortened life expectancy and a high symptom burden. They will benefit from early supportive care interventions. The goal of supportive care is to relieve suffering and to support the best possible quality of life for patients and their families, regardless of their stage of disease or the need for other therapies, in accordance with their values and preferences. Developing a patient-centered approach, with a patient-centered care plan, which includes conservative, nondialytic care, is increasingly recognized as an important issue when caring for advanced chronic kidney disease patients, in particular those who are elder and with multiple comorbidities. When treating these patients, unavoidably, ethical issues arise. Current clinical practice guidelines consider some of them, but there is a lack of comprehensive information about the full range of relevant ethical issues in this condition. Palliative care is sometimes referred to as supportive care; its goal is always to achieve the best possible quality of life by controlling symptoms, relieving pain, and restoring functional capacity while respecting the patients personal, cultural, and spiritual beliefs and practices.