A review of supportive care for older people with advanced chronic kidney disease

Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focusing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognizing that frailty, multi-morbidity and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritize quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD. Lay Summary Older people with advanced chronic kidney disease (CKD) are more likely to experience frailty and multiple other medical problems (comorbidity). This can result in impaired quality of life and reduced survival compared with younger adults with the same diagnosis. The benefits to be derived from kidney-specific treatments such as dialysis and transplantation are also less well-defined in older adults. Supportive care (SC) involves honest communication with the person about their disease, the treatments available to them and prognosis. Through shared decision making, the person and their doctor will try determine what is important to the person and address those aspects of disease that are contributing most to the person's suffering now, while also making plans for the future. This article provides an overview of SC principles in the older adult with advanced CKD.