End of life care is now recognised as part of the much wider area of palliative care and supportive care for people living, sometimes for years, with life threatening conditions including Chronic Kidney Disease (CKD).
A number of initiatives have highlighted the importance of this area for all, not just those with cancer. The National Palliative Care Team has developed advice on triggers for Inclusion in the “Gold Standards Supportive Care Register”.(Link to the Gold Standards Framework Website)
A number of patients with Chronic Kidney Disease do need palliative / supportive care and therefore should be included on the register. Inclusion on the register should be considered in patients with 2 of the following:-
CKD stage 5 (eGFR < 15 ml/min) or in frail individuals CKD stage 4 (eGFR 15 - 25 ml/min).
Patients thought to be in the last year of life by the care team - the 'surprise question'.
Patients choosing the no dialysis option, discontinuing dialysis or opting not to restart dialysis if their transplant is failing.
Difficult physical symptoms (e.g. anorexia, nausea, pruritus, reduced function status, intractable fluid overload) or psychological symptoms despite optimal tolerated therapy.
A palliative care domain has also been included within the new Quality and Outcomes Framework and requires practices to provide a complete register for all patients in need of palliative/supportive care.
Palliative Care and the GMS Contact-PDF (122KB)