Palliative care and withholding and withdrawing dialysis

The aging dialysis population, with its decreasing functional status, the high mortality of end-stage renal disease (ESRD), and the rise of palliative medicine as a specialty have all served to promote the importance of end-of-life care for ESRD patients. Even though nephrologists have an increased understanding of the issues involved in ESRD end-of-life care, most individuals working in dialysis know of a case in which it felt as if “the dead were being dia-lyzed.” An increased effort to focus on palliative care issues in ESRD, especially advance care planning, may serve to reduce the frequency of such cases.