Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Communication
Case Report
Case Series
Conference Abstract
Conference Editorial
Conference Proceedings
Current Issue
Editorial Commentary
General Medicine, Case Report
IAPCONKochi 2019 Conference Proceedings
Letter to Editor
Letter to the Editor
Letters to Editor
Narrative Review
Original Article
Palliative Medicine, Letter to the Editor
Personal Reflection
Position Paper
Position Statement
Practitioner Section
REPUBLICATION: Special Article (Guidelines)
Review Article
Short Communication
Short Report
Special Editorial
Special Review
Systematic Review
View/Download PDF

Translate this page into:

Editorial Commentary
20 (
); 99-100

End-of-Life Care for Patients Afflicted with Incurable Malignancy and End-Stage Renal Disease

Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
Address for correspondence: Dr. Dipankar Bhowmik; E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

Source of Support: Nil.

Conflict of Interest: None declared.

End-stage renal failure (ESRD) patients (even without associated malignancy) have a high mortality and morbidity. As per the US Renal Data System (USRDS), the annual crude mortality is approx 20%.[1] The added presence of incurable malignancy definitely worsens the clinical outcomes in terms of quality of life, morbidity and mortality. Hence the utility (or otherwise) of initiating/continuing dialysis must always be assessed in a holistic manner.[2] However, currently most nephrologists are not comfortable with the idea of either withholding or withdrawing dialysis in these clinical settings. A recent study amongst US nephrology fellows revealed that more than two-thirds of the respondents thought that a formal rotation in palliative care during fellowship would be useful.[3] It is in this context that the article by Jing et al. in the current issue of the Journal throws light on management of patients afflicted with incurable malignancy and ESRD requiring dialysis support therapy.[4] As highlighted by the authors these patients have multiple co-morbidities with poor nutrition accompanied by anxiety and depression. The prevalence of such cases in the population is on the rise. Not addressing the need of palliative care in these patients may in fact subsequently lead to tribulation for the patient and the family.[5]

The primary goal of palliative care is alleviation of suffering and improving the quality of life of both the patients and their families. Management of renal failure by peritoneal dialysis (PD), which can be conveniently performed both at home and in the hospice setting, is thus of great help. Delivering the usual optimal dialysis dose in these patients would have limited clinical benefits. Rather, the patient would benefit from the treatment of the various associated symptoms. One of the problems of renal failure is fluid overload which can lead to distressing dyspnea and/or orthopnea. This can be treated/prevented with fluid restriction, diuretics and PD with exchanges of hypertonic glucose solution. Even in cases where PD has been withdrawn, intermittent PD exchanges can easily be done when required to remove extra fluid for the relief of the patient. The other frequent problem in such patients is chronic pain. This can be treated with the various available medications (including opioids) with appropriate dosage adjustment for renal failure. Other symptoms like nausea, pruritus, etc., can also be treated with drugs. Sedatives may also be used as necessary. Unnecessary use of dialysis only increases the cost of health care without accrual of significant benefits to the patients, their families or the society as a whole. Hence universal screening of all ESRD patients for palliative care needs has now been proposed.[6] The time has come for nephrology teams to work in tandem with palliative care practitioners for the care of these patients.[78]


  1. Mortality and morbidity in patients with chronic kidney disease. 201363-72.
    [Google Scholar]
  2. , , . “Should I go on dialysis, Doc?”. Can Fam Physician. 2012;58:1353-6.
    [Google Scholar]
  3. , , , , . Palliative care experience of US adult nephrology fellows: A national survey. Ren Fail. 2013;36:39-45.
    [Google Scholar]
  4. , , , . 2013
  5. , , , , , , . Contrasting approaches to end of life and palliative care in end stage renal disease. Indian J Nephrol. 2012;22:307-9.
    [Google Scholar]
  6. , , . Five policies to promote palliative care for patients with ESRD. Clin J Am Soc Nephrol. 2013;8:1783-90.
    [Google Scholar]
  7. , , , , , , . Renal supportive care and palliative care: Revision and proposal in kidney replacement therapy. Nefrologia. 2012;32:20-7.
    [Google Scholar]
  8. , , . Should there be an expanded role for palliative care in end-stage-renal disease? Curr Opin Nephrol Hypertens. 2010;19:556-60.
    [Google Scholar]

    Fulltext Views

    PDF downloads
    View/Download PDF
    Download Citations
    Show Sections