Illness trajectories: An important concept in the management of kidney failure

With increasing numbers of patients reaching stage 5 CKD, it is vital that we understand the terminal phases of renal failure. The concept of disease trajectories provides a useful way to do this. Care for the renal patient in the last months of life has received much less attention than many other areas of nephrology. Yet this phase of illness needs equal levels of attention if we are to ensure good quality of death for all [17]. Collaboration between nephrology and palliative care provides the best chance for rapid improvements in care. The data available on disease trajectories are one example of the useful cross-fertilization between these specialities that can inform both patients and health care professionals, and allow us to improve quality of care. Although there is little evidence available as yet on trajectories in the renal population, the disease trajectories developed in other end of life populations are a useful way of conceptualizing and understanding care in the last months and weeks of life, to provide a basis for further research, and rapidly identify ways to improve care towards the end of life.