Palliative peritoneal dialysis programmes: narrative review - from theory to practice

Abstract

Background: End-stage kidney disease (ESKD) significantly impacts global public health, driven by an ageing population and increased chronic diseases. Over half of patients with ESKD are now over 65 years old, often with multiple comorbidities, complicating management and prognosis. The socioeconomic impact is considerable, and patients with ESKD face higher cancer risks. The interplay of kidney failure, cancer risk and comorbidities underscores the need for integrated care, including palliative care. Palliative peritoneal dialysis (PD) focuses on patient comfort, quality of life and autonomy, integrating palliative principles into dialysis. Objective: This review aim to help construct palliative PD programmes for patients with ESKD in th end stage of life. Design: A comprehensive review of existing literature on palliative care integretion in dialysis with emphasis on PD. Methods and data sources: This review synthesized evidence from 37 reference encompassing the rationale,infrastructure, clinical protocols and reported outcome of palliative PD the implementation, challenges and benefits of palliative PD. Findings: Palliative PD supports patient-centred care with flexible treatment schedules and reduces the physical burdens of in-centre dialysis. Key components include shre decision-making, symptom control and patient autonomy. Effective implementation requires training healthcare providers and fostering multidixciplinary collaboration. Conclusion: Palliative PD represents a shift in treating advanced kidney disease, highlighting the importance of symptom relief, psychological support and patient empowerment.