Palliative care in the treatment of end-stage renal failure.

Palliative care begins with establishing goals of care based on estimated prognosis in end-stage renal disease (ESRD). Patients with ESRD are increasingly characterized by older age and multiple comorbid illnesses, and have a mortality rate 8 times higher than the general Medicare population. Dialysis patients are appropriate for palliative care because of their high mortality rate and high symptom burden. More patients and families are choosing not to start or withdraw dialysis for multiple reasons, particularly in patients older than 60 years. Advance directives and resuscitation directives are important in ensuring compassionate and goal-directed palliative care of ESRD patients. Drug toxicities are avoidable by using appropriate drugs at the correct doses and dosing intervals.