Developing and sustaining a renal supportive care service for people with end-stage kidney disease

Background The poor, self-reported quality of life, high symptom burden and complex care needs of dialysis patients prompted the development of a renal supportive care service at St George Hospital. Aim To report the development of a renal supportive care service at St George Hospital and methods used to sustain its growth. Method Supportive care consists of outpatient and inpatient services with four specific groups of patients identified as the primary clientele. These groups are those on a conservative (non-dialysis) pathway, end-stage kidney disease (ESKD) patients with a symptom burden requiring specialised management, patients on dialysis considering dialysis withdrawal and ESKD patients with cancer. Services consist of complex symptom management, end-of-life (EOL) care and coordination of services to assist the patient to stay at home as long as they are able. Conclusion The future of the supportive care service looks promising; therefore, it is important to incorporate this as part of routine patient care in ESKD. There is a need to pass on renal supportive care knowledge to the renal care teams to assist ESKD patients to live as well and as comfortably as possible, whether they choose a dialysis pathway or not, and to engage in clear conversations with patients and carers throughout the disease trajectory. Keywords End-stage kidney disease, supportive care, palliative care, dialysis, renal.