Interest in palliative care has increased in recent times, particularly in its multidisciplinary approach developed to meet the needs of patients with a life-threatening disease and their families. Although the modern concept of palliative simultaneous care postulates the adoption of these qualitative treatments early on during the life-threatening disease (and potentially just after the diagnosis), palliative care is still reserved for patients at the end of their life in most of the clinical realities, and thus is consequently mistaken for hospice care. Patients with acute or chronic kidney disease (CKD) usually experience poor quality of life and decreased survival expectancy and thus may benefit from palliative care. Palliative care requires close collaboration among multiple health care providers, patients, and their families to share the diagnosis, prognosis, realistic treatment goals, and treatment decisions. Several approaches, such as conservative management, extracorporeal, and peritoneal palliative dialysis, can be attempted to globally meet the needs of patients with kidney disease (e.g., physical, social, psychological, or spiritual needs). Particularly for frail patients, pharmacologic management or peritoneal dialysis may be more appropriate than extracorporeal treatment. Extracorporeal dialysis treatment may be disproportionate in these patients and associated with a high burden of symptoms correlated with this invasive procedure. For those patients undergoing extracorporeal dialysis, individualized goal setting and a broader concept of adequacy should be considered as the foundations of extracorporeal palliative dialysis. Interestingly, little evidence is available on palliative and end of life care for acute kidney injury (AKI) patients. In this review, the main variables influencing medical decision-making about palliative care in patients with kidney disease are described, as well as the different approaches that can fulfill the needs of patients with CKD and AKI.

Background: In recent years, the palliative care (PC) paradigm is evolving from a prognosis-based approach to one centered on complexity, also in response to the aging population and the increase in chronic diseases. It is therefore necessary to strengthen PC networks with effective management of the specialist resources available. The use of tools such as the spanish Diagnostic Instrument for Complexity in Palliative Care (IDC-Pal) can help evaluate the complexity of PC needs, thus guiding the clinical care response. The aims of this study were the translation and the cultural adaptation of the IDC-Pal tool to the Italian language. Methods: The methodology proposed by Beaton et al. and Sousa et al. was used for the translation and cultural adaptation of the IDC-Pal tool. Phase 1: a forward–backward translation with linguistic and cultural adaptation of the tool by two native Spanish translators and two native Italian translators, including two PC professionals and two nonprofessionals, was performed. Phase 2: the translation was evaluated by a panel of 12 Italian PC experts, who assessed the comprehensibility of the translated instrument, and proposed changes to the text, which was found to be incomprehensible to at least 20% of them. Phase 3: this version of the tool was proposed to a sample of the Italian target population (93 professionals including general practitioners, nurses, and hospital doctors at 9 Italian PC networks tested it on 168 patients in home and hospital settings), to evaluate its comprehensibility and usability. At the end of the experimental phase, a semi-structured interview was organized with the main researcher of each network, with the aim of receiving information about the comprehensibility of the tool. Finally, a definitive version was developed. Results: The translation and adaptation were achieved without major problems. Conclusions: A conceptually, culturally, and linguistically equivalent italian version of the original IDC-Pal was obtained.

Heart failure (HF)—a highly prevalent condition among older adults—is characterized by recurrent exacerbations and progressive symptom burden, significantly affecting functional autonomy and quality of life. Palliative care may alleviate symptoms and improve quality of life for patients and their families, promoting personalized care aligned with individual preferences. Although international guidelines recommend the early integration of palliative care into standard HF management, its implementation in real-world practice remains limited. Improving awareness and competencies in identifying end-of-life needs and in advance care planning may facilitate earlier integration of palliative care into HF clinical pathways. This paper presents a case of advanced HF in which palliative care was introduced only during the final hospitalization, highlighting the importance of the earlier integration of palliative care throughout the disease trajectory. This paper results from a collaboration between young members of the Italian Society of Palliative Care and the Italian Society of Gerontology and Geriatrics. The case serves as a practical training model for healthcare professionals in applying a palliative care approach to advanced HF. It illustrates key strategies and tools employed across different stages of care, including patient identification, multidimensional assessment, shared decision-making, advance care planning, symptom management, medication review, and palliative sedation.