While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well-informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever

option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which learn more patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces check details the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis

is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence-based guidelines, core curricula, position statements, standards and tools in palliative care in end-stage kidney disease. The role of palliative care in end-stage kidney disease (ESKD) is well developed in the UK, USA, Italy and Canada.1–9 Palliative care in ESKD is important in the contexts of conservative therapy (choosing a non-dialysis pathway), withdrawal of therapy and in symptom control. Advanced care directives and end-of-life decisions overarch these pathways. There is a recognized need for education regarding provision of palliative care in

dialysis patients.10 However, there is no clear pathway to palliative care,11 considerable variation in the provision of palliative care services for ESKD patients12 Bumetanide and little evidence upon which to develop standards of renal palliative care in ESKD.13 There has been an increase in the elderly accepted onto dialysis in Australia. In 2004, 244 (445 per million population) new patients were accepted on dialysis in the 75–79 year age group. This increased to 277 (504 per million) in 2008. In the 80–84 year age group 103 (267 per million) started dialysis in 2004, which increased to 187 (442 per million) in 2008 and in the >85 year group 32 (107 per million) started dialysis in 2004, which increased to 58 (159 per million) in 2008.14 Despite this, the Caring for Australasians with Renal Impairment (CARI) Guidelines do not address palliative care.15 In addition, many elderly assessed for dialysis either do not progress16 or die before they would have required dialysis therapy.17 We will review the existing literature on palliative care provision in ESKD in the contexts of conservative therapy and withdrawal from dialysis. The available observational, retrospective and case studies are summarized in Table 1.