A visiting palliative care specialist from St George Hospital provides an

outreach service as well as phone advice, support and ongoing education to up skill local practitioners and trainees. This team approach SCH 900776 has improved the services and outcomes for patients on non-dialysis pathways but also those on a dialysis pathway as an unintended ripple effect with different approaches to symptom control. The role of the supportive care nurse in this model is critical to the success of this model promoting a wider referral base especially from dialysis nurses and Allied health. The caring physician’s may not always be aware of the iceberg of symptoms that are very apparent to the dialysis staff that care for these patients during the long hours of dialysis. A similar model is being set up in Western Australia linking into existing palliative care services if available.[11] Options for certification in renal supportive care for nurses and allied health professionals and ongoing education in renal supportive care need to be explored with the Renal Society GSK126 of Australasia (RSA). Robyn Langham General practitioner are important and should be involved in decision

making and advanced care planning (ACP) for patients with advanced kidney disease. Advanced kidney disease has a biphasic nature of life trajectory. No treatment does not mean no dialysis for the patient with chronic kidney disease (CKD) – CKD care and terminal phase care. For patients and their families undergoing renal supportive care, their primary care physician is an integral member of the multidisciplinary team. From a generic palliative care viewpoint, the Gold Standards Framework[1] outlines the importance of the general practitioner in palliative Dimethyl sulfoxide care, the importance of enhancing knowledge and understanding of palliative care and underlines the need for effective communication, coordination and continuity of care. It emphasizes

the importance of case identification, holistic assessment, care planning, individual case discussions and case management by a multidisciplinary team as well as family and carer’s assessment and support. These principles can be directly applied when evaluating the role of the primary care physician in renal supportive care. Recent data from the AIHW indicates that for every new case of end-stage kidney disease (ESKD) treated with renal replacement therapy (RRT – dialysis or transplantation), there is one that is not, although the vast majority of those not treated are elderly. Furthermore, the rate of non-RRT treatment varies greatly with age, with RRT rates dropping progressively over the age of 65, with only about one-tenth of those aged 80 years or over receiving dialysis or transplant.