How early do you involve palliative care in the management of a CKD Stage 5 patient who does not wish to pursue renal replacement therapy?  

I tend to refer as soon as they are clear that they do not want to pursue renal replacement therapy for a couple of reasons: (1) By CKD 5, even if they do not have uremic symptoms, it is nice to establish longitudinal care with palliative care so that there is a strong relationship with trust when ...