Renal supportive and palliative care: position statement.

Since the introduction of hemodialysis in the management of acute kidney injury in the 1940s and for chronic kidney disease in the 1960s dialysis has become one of the most successful advances in medical technology, with almost 11,000 patients currently receiving dialysis in Australia and almost 2500 in New Zealand. Like all medical technologies, its place continues to evolve. For a time, dialysis was seen as a treatment best delivered only to younger patients without diabetes; today the greatest uptake of dialysis is in patients over age 65 and the most common cause of needing dialysis is diabetes. Along with these extended criteria for dialysis, that have evolved over many years, has come the recognition that the older dialysis patient often has considerable co-morbidity and frailty, that time spent on dialysis is not always beneficial to these patients and that their overall prognosis is considerably worse than their younger counterparts. CARI guidelines recommend that “an expectation of survival with an acceptable quality of life” is a useful starting point for recommending dialysis.