This chapter describes the issues associated with providing palliative care to patients with renal failure, and covers initiation of renal replacement therapy, conservative treatment, symptom management for patients with advanced renal disease, and issues surrounding stopping renal replacement therapy. As obesity and diabetes increase, so does the incidence of chronic renal disease and end-stage renal failure. Determining the exact number of patients dying of renal failure is challenging. Often the cause of death will be ascribed to an associated contributing factor, e.g. diabetes mellitus, or the final acute event resulting in death, e.g. myocardial infarction. However, we know that renal failure is an independent risk factor for cardiovascular disease and is associated with a high all-cause mortality.1 In addition, patients with end-stage renal failure have a significant symptom burden and therefore it is important that patients have access to palliative care services to assist with symptom management, advanced care planning, and, where appropriate, decisions around dialysis and transplantation.
