As well as raising awareness of this patient group, and help in the identification of these patients within the primary care setting, it is equally important to provide easily accessible information on the renal-specific palliation needs of these patients. The life trajectory of ESKD is often one of relative preserved functional status until late in the course of the illness, which is characterized by a rapid decline toward death.[3] This has clinical implications in delivery of care, with initial

focus on CKD management – preventing progression of disease and management of CKD related complications, in the largely asymptomatic apparently well patient, followed by the more rapid phase of terminal uraemia, during which patients may experience a wide range of symptoms. Alisertib Ulixertinib purchase Communication with and from the patient’s

renal unit is vital. Of prime importance is to check what if any conversations and decisions about ACP have been made. This is particularly important for the patient who wishes to die at home, a situation where the general practitioner becomes central to the coordination of care. A number of resources exist to assist the GP in ACP discussions with patients and their families. Though there are legal differences in ACP from state to state, and country to country, The RACGP Guidelines for ACP[4] contains a wide range of almost useful resources. Resources to guide renal supportive care of the patient with advanced CKD A. CKD management issues The main focus in the early phase is the care of the CKD patient to reduce progression of disease and manage other complications – a no-dialysis option does not mean a no-treatment

option. Actively treating the metabolic complications of advanced CKD can improve quality of life and reduce the symptom burden. The principles of managing anaemia with erythropoietin stimulating agents, CKD-MBD (phosphate binders, active Vitamin D), hypertension, fluid management and specific considerations regarding drug dosing in advanced CKD, contained in the Chronic Kidney Disease Management in General Practice.[5] B. Care of terminal phase of ESKD Patients with advanced CKD can look relatively well until the more advanced stages of uraemia. They can experience the whole range of symptoms more commonly associated with oncology palliation. These include pain, restless legs, nausea and vomiting, retained secretions, dyspnoea, and terminal agitation. Treatment options and doses are often constrained in patients with very low levels of renal function. For the patient who chooses to die at home, the GP will play a pivotal role in coordinating the medical care of the patient, working closely with the local palliative care service. Many of the palliative care units are able to visit patients at home and liaise with the patient’s GP regarding symptom control.