Palliative care in patients with advanced chronic kidney disease (stage 5) not amenable to dialysis treatment

Palliative care is not "the absence of KRT", but an alternative to it in very selected cases. Both the patient and the family should have the absolute certainty that noninclusion or "deselection" for KRT does not imply a reduction in the medical care received by the patient or a survival of worse quality. The two main causes for deselection are the patient's refusal to enter dialysis and the presence of severe associated comorbidity. Each center should assess these figures, their own estimates, the availability of resources and their organizational capacity to determine whether to initiate or not a specific program of palliative care in end-stage (PCU-ACKD). Follow-up will be made both in the hospital and at home. Home care of the end-stage uremic patient will require involvement of the family and especially of a primary caregiver to support the process, centralize patient care and handle relations with the care team. Appropriate information and training of the caregiver will allow patient care to be carried out in the patient's usual home environment and reduce the anxiety and overload of the person taking on the main responsibility for care.