The UK Expert Consensus Group have developed BI 6727 research buy evidence-based guidelines for symptom management in adults who are dying from ESKD.4 These guidelines developed from the Liverpool Care Pathway for the Dying Patient, which was used initially for terminal cancer but subsequently for stroke and heart failure patients. An Expert Consensus Group for patients dying with renal failure found those dying with renal failure had similar symptoms to those dying with terminal cancer hence the Renal Liverpool Care Pathway prescribing guidelines

were developed with the aim of controlling these symptoms.78 The NKF KDOQI guidelines state Nephrologists should be familiar with the principles of palliative care and should not neglect hospice referral for patients with advanced kidney failure.2,5 The CARI guidelines do not address palliative care15 and formulating guidelines in the Australian context should be a high priority. However, the Kidney Health Australia website provides information for patients on conservative approaches both pre-dialysis and withdrawing from dialysis.79 National Kidney Foundation core curriculum in nephrology summarized the relevance of palliative care and see more its incorporation into

dialysis units.5 It highlights the usefulness of advanced care planning in patients with ESKD and strategies to increase its use. The American Society of Nephrology and the Renal Physicians Association produced a position statement on End of Life Care in 2002.1 This is a comprehensive document that addresses

advanced care planning and directives, hospice care and palliative care. It also makes recommendations, which includes ensuring education of multidisciplinary renal team members in palliative care principles including Calpain advanced care planning, supporting the patient requesting dialysis withdrawal with palliative care referral and the development of renal unit policies and protocols to ensure advanced care planning occurs. The Renal Physicians Association and the American Society of Nephrology also provide a clinical practice guideline on dialysis initiation and withdrawal.80 Standards for providing Quality Palliative Care for all Australians were published in 2005.81 Although there is no specific reference to patients with kidney disease the standards provide guidelines that can be applied to all diseases. The standards do emphasize the need to encompass the patient and their family’s wishes and needs in the decision-making process of care planning. In addition, access to palliative care services should be available independent of diagnosis and should be based on clinical need. The only tool in the public domain that we could find was in the National Health Service National End of Life Care Program to enhance end-of-life care in those without cancer. It introduced the tool to support patients with kidney failure.