Palliative Care and Renal Medicine joining forces

This year marks the 16th year of operation of St George Hospital Renal Department’s successful Kidney Supportive Care Program

The program commenced in 2009 following the recognition of a large and growing number of older people with kidney failure who also live with co-existing chronic diseases.

Many of these patients were suffering from symptoms of kidney failure, which did not improve with dialysis, as well as the physical, psychological and logistical demands of dialysis itself.

The program was pioneered to improve the symptom control and quality of life for people receiving dialysis and for those where dialysis was unlikely to make them live longer or improve their quality of life.

Since 2009, the project has managed approximately 1,600 patients, the majority as out-patients, including 525 patients with kidney failure who have made a shared decision to follow conservative kidney management. This is a holistic style of care which aligns with the individual preferences and goals of patients over the rigorous demands of dialysis.

“More than 82 per cent of our patients with kidney failure who are over age 80 are choosing the conservative kidney management pathway. This suggests that older people are choosing care that aligns with their individual preferences and goals, empowering themselves and their families to receive value-aligned healthcare at the end of life.” said Dr Kelly Li, Staff Specialist Nephrologist and Palliative Care Physician, St George Hospital.

The Kidney Supportive Care Team prioritises education, family involvement, honest discussions, advance care planning and a holistic approach to support informed decisions for their clients.

Having pioneered the approach in Australia, the project has continued to help lead international developments. This includes playing key roles in the International Society of Nephrology, which is now developing online learning tools for Kidney Supportive Care with the project’s input.

“Patients with renal failure who don’t undertake dialysis under this program live for an average of 14 months and the majority experience improvement in their quality of life. This is a remarkable achievement for a group of people severely impacted by chronic disease, who, with the help of our specialists, were able to live better in their last year or two of life,” said Dr Li.

“The care the Kidney Supportive Care Team provides to individuals and their families extends beyond death to bereavement. The team continues to receive appreciative feedback from patients and families who have put their trust in our team to look after them during a complex time. This is testament to their compassion and innovative approaches.”

Published 17 March 2025