Rationalising supportive therapies for chronic kidney disease in palliative care

Follow the principles of medication rationalisation when rationalising supportive therapies for chronic kidney disease in palliative care.

Patients with palliative care needs who have advanced chronic kidney disease may be maintained with dialysis or follow a conservative pathway without dialysis.

For patients receiving dialysis, supportive therapies will generally be continued until dialysis is withdrawn.

For patients not receiving dialysis:

• continue calcium and vitamin D supplements until the last weeks of life because of the risk of hypocalcaemia
• reduce phosphate binders (eg sevelamer) as the patient’s oral intake decreases until stopped
• continue drugs used to prevent anaemia (eg erythropoietin agonists, iron) until the last weeks of life because these drugs prevent fatigue and manage symptoms.

For principles of palliative care for patients with chronic kidney disease, see Principles of palliative care for patients with chronic kidney disease.