Radically Rethinking Renal Supportive and Palliative Care in South Africa

Abstract The incidence of end-stage kidney disease [ESKD] is increasing worldwide however due to resource constraints, access to life saving kidney replacement therapy [KRT] remains limited in the state sector in South Africa. National guidelines mandate that only patients who are transplantable be accepted onto state chronic dialysis programmes. Once a patient is transplanted there is an opportunity for a new patient to access a chronic dialysis slot. Given the resource scarcity, the South African Constitutional Court has ruled that rationing of dialysis is appropriate, however this is not without cost both to patients and decision makers. Patients, both adults and paediatric, are often placed on a palliative care pathway not through choice, but through circumstance. Renal supportive and palliative care involves an interdisciplinary approach to manage patients with ESKD to ensure that symptoms are managed optimally and to provide support during advanced disease. Innovative ways to address patient care at any age, must to be sought to ensure non-abandonment and adequate care with our limited resources.