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

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 paper addresses the key considerations of supportive care as part of integrated end-stage kidney disease care (ESKD), with particular attention paid to programs in low- and middle-income countries. Supportive care should be an integrated component of care for those with advanced chronic kidney disease, those receiving kidney replacement therapy (KRT), and those 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 five domains, before exploring their consequences in four health care situations/settings – in people approaching ESKD 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.