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

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


Barnaby Hole

Brenda Hemmelgarn

Edwina Brown

Mark Brown

Mignon I. McCulloch

Carlos Zuniga

Sharon P. Andreoli

Peter G. Blake

Cécile Couchoud

Alfonso M. Cueto-Manzano

Gavin Dreyer

Guillermo Garcia Garcia

Kitty J. Jager

Marla McKnight

Rachael L. Morton

Saraladevi Naicker

Gregorio T. Obrador

Jeffrey Perl

Muhibur Rahman

Kamal D. Shah

Wim Van Biesen

Rachael C. Walker

Karen Yeates

Ming Hui Zhao

Alexander Zemchenkov

Simon J. Davies

Fergus J. Caskey



© 2020 International Society of Nephrology 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.


Hole, B., Hemmelgarn, B., Brown, E., Brown, M., McCulloch, M. I., Zuniga, C., Andreoli, S. P., Blake, P. G., Couchoud, C., Cueto-Manzano, A. M., Dreyer, G., Garcia Garcia, G., Jager, K. J., McKnight, M., Morton, R. L., Murtagh, F. E., Naicker, S., Obrador, G. T., Perl, J., Rahman, M., …Caskey, F. J. (2020). Supportive care for end-stage kidney disease: an integral part of kidney services across a range of income settings around the world. Kidney International Supplements, 10(1), e86-e94.

Journal Article Type Article
Acceptance Date Nov 7, 2019
Online Publication Date Feb 19, 2020
Publication Date Mar 1, 2020
Deposit Date Feb 23, 2020
Publicly Available Date Feb 20, 2021
Journal Kidney International Supplements
Print ISSN 2157-1716
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 10
Issue 1
Pages e86-e94
Keywords Nephrology; conservative care; end-stage kidney disease; palliative care; supportive care
Public URL