title: Palliative and end-of-life care issues in chronic kidney disease.
abstract: OBJECTIVE
  Patients with progressive chronic kidney disease (CKD) have high morbidity, mortality, and symptom burden. Cardiovascular disease (CVD) and congestive heart failure (CHF) often contribute to these burdens and should be considered when providing recommendations for care. This review aims to summarize recent literature relevant to the provision of palliative and end-of-life care for patients with progressive CKD and specifically highlights issues relevant to those with CVD and CHF.
  
  
  RESULTS
  Dialysis may not benefit older, frail patients with progressive CKD, especially those with other comorbidities. Patients managed conservatively (i.e., without dialysis) may live as long as patients who elect to start dialysis, with better preservation of function and quality of life and with fewer acute care admissions. Decisions regarding dialysis initiation should be made on an individual basis, keeping in mind each patient's goals, comorbidities, and underlying functional status. Conservative management of progressive kidney disease is frequently not offered but is likely to benefit many older, frail patients with comorbidities such as CHF and CVD.
  
  
  CONCLUSIONS
  A palliative approach to the care of many patients with progressive CKD is essential to ensuring they receive appropriate quality care.
authors.affiliation: aDepartment of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA bDivision of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Combs
authors.forename: Sara N
authors.initials: SN
authors.lastname: Davison
mesh_terms: D032722:Advance Care Planning; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration*; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D013727:Terminal Care / Q000458:organization & administration*