Background Patients with end stage renal failure on dialysis have a high symptom burden (Murtagh, Addington-Hall & Higginson, 2007) and survival on dialysis can be comparable to some cancers (Nordio, Limido, Maggiore et al., 2012). Increasingly it is recognised that patients with advancing age and comorbidities may benefit from a conservative approach rather than dialysis (Chandna, Da Silva-Gane, Marshall et al., 2011). Patients with non-malignant disease often receive palliative services late or not at all (Allsop, Ziegler, Mulvey et al., 2018).

Aims To improve renal palliative integration, education and support for patients with End Stage Renal Failure (ESRF), including those on renal replacement therapy and those opting for conservative kidney management.

Methods Development of a monthly renal palliative MDT meeting alongside a biannual two- day renal education programme.

Results From April 2017 to April 2018, 36 patients were identified and included in multidisciplinary discussion. Average age 74 (range 44 to 88 years). Majority included were haemodialysis (HD) patients (27). Six patients had cancer in addition to ESRF. There were 19 deaths during the period. In 71% of patients who died on HD, dialysis had been withdrawn prior to death. 74% of patients died at home or in the hospice. In 52% there was documented advance care planning (escalation decisions and DNAR).

Conclusion A monthly MDT improved access by identifying patients earlier. The referrals have been appropriate and controlled in number. The majority of patients died out of hospital. In our population, HD patients seem to have greater need for referral. Delegates attending the education programme reported an improved confidence in approaching end of life issues and a recognition of the benefits of a collaborative approach. A greater understanding of the population we support and mutual education has resulted in closer working relationships and increased referrals.

Further development of a joint Nephrology/Palliative clinic is planned. A focus group to identify patient and carer needs and experiences is planned.