In the UK, government guidelines related to chronic illness are being used to enhance supportive care of renal patients. Good practice includes ensuring the views of patients and carers are taken into account when developing and evaluating palliative care services. The literature relating to a renal patient's decision not to dialyse is sparse and the evidence base upon which to support effective nursing practice is currently weak. Much can be drawn from the discipline of cancer nursing, however, further research needs to be undertaken to develop new knowledge within the realm of supportive renal care. Having a fuller understanding of how, and when, renal patients finally make difficult end-of-life decisions is crucial in order to offer effective support and deliver an efficient and valuable renal supportive care service.