Supportive care for end-stage kidney disease: an integral part of kidney services across a range of income settings around the world

Barnaby Hole, Brenda Hemmelgarn, Edwina Brown, Mark Brown, Mignon I. McCulloch, Carlos Zuniga, Sharon P. Andreoli, Peter G. Blake, C. cile Couchoud, Alfonso M. Cueto-Manzano, Gavin Dreyer, Guillermo Garcia Garcia, Kitty J. Jager, Marla McKnight, Rachael L. Morton, Fliss E. M. Murtagh, Saraladevi Naicker, Gregorio T. Obrador, Jeffrey Perl, Muhibur RahmanKamal D. Shah, Wim van Biesen, Rachael C. Walker, Karen Yeates, Alexander Zemchenkov, Ming-Hui Zhao, Simon J. Davies, Fergus J. Caskey

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19 Citations (Scopus)


A key component of treatment for all people with advanced kidney disease is supportive care, which aims to improve quality of life and can be provided alongside therapies intended to prolong life, such as dialysis. This article addresses the key considerations of supportive care as part of integrated end-stage kidney disease care, with particular attention paid to programs in low- and middle-income countries. Supportive care should be an integrated component of care for patients with advanced chronic kidney disease, patients receiving kidney replacement therapy (KRT), and patients receiving non-KRT conservative care. Five themes are identified: improving information on prognosis and support, developing context-specific evidence, establishing appropriate metrics for monitoring care, clearly communicating the role of supportive care, and integrating supportive care into existing health care infrastructures. This report explores some general aspects of these 5 domains, before exploring their consequences in 4 health care situations/settings: in people approaching end-stage kidney disease in high-income countries and in low- and middle-income countries, and in people discontinuing KRT in high-income countries and in low- and middle-income countries.
Original languageEnglish
Pages (from-to)e86-e94
JournalKidney international. Supplement
Issue number1
Publication statusPublished - Mar 2020


  • conservative care
  • end-stage kidney disease
  • palliative care
  • supportive care

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