End-stage kidney disease

Abstract

End-stage kidney disease accounts for 1–2% of all deaths. With ageing of the population, this proportion will grow steadily over the coming years. Symptom burden in end-stage kidney disease exceeds advanced cancer, with added renal-specific symptoms, such as itch and restless legs. Pain and depression are also more prevalent. Many renal symptoms go under-recognized and undertreated, especially as they arise from comorbid conditions, rather than the renal disease itself. The most useful intervention to address symptoms is regular assessment, followed by pharmacological interventions that take account of the constraints on using renally cleared drugs and the high risk of toxicity from accumulation of parent compounds or metabolites. The population with end-stage kidney disease have extensive palliative care needs, and require significant medical, nursing, psychological, and social care to address these as their illness advances towards the end of life.