The goal of palliative care is to achieve good quality of life for patients with chronic life-limiting illnesses, and their families, through assessment and management of physical, psychosocial and spiritual problems and needs. Patients with kidney diseases present a particular target of such care from the time of diagnosis to the time of family bereavement family. End-stage renal disease is associated with limited life expectancy, high morbidity and considerable burden of symptoms especially in elderly patients. Nephrologists who are not prepared for the holistic aspects of care of such patients, frequently encounter high mortality rates. Pain and other physical, psychosocial and spiritual symptom management appear to be an important issue in nephrology. Withdrawal from dialysis is another problem that may require special attention in the form of legal and ethical guidance.