Recently there has been a growing awareness that not all patients with Established Renal Failure will benefit from dialysis treatment, and it has been recognised that this patient population requires an enhanced approach to assessment and control of symptoms, as well as supportive management, including effective and high-quality palliative care. This overview of the literature examines supportive care for the patient with Established Renal Failure and how conscious decision-making in this group of patients can be best facilitated. It highlights recommendations, which have been produced to assist in the decision-making process regarding withholding and withdrawing dialysis, and is a starting point prior to establishing supportive care programmes for the renal population. Patients who decide to abstain from dialysis or for whom such a decision is made should be offered appropriate supportive and palliative care.