The following End of Life Care tools provide practical guidance and support to help health and social care staff to implement the National Ambitions for Palliative and End of Life Care.

Symptom control measures should be modified in cancer patients who have concurrent renal failure as well as those with non malignant causes of end stage renal failure.

Cancer patients may develop renal impairment due to:

  • ureteric obstruction caused by compression by a pelvic tumour, or
  • as a consequence of a concurrent illness

If clinically appropriate the origin of the renal impairment should be investigated and corrected if possible

e.g. stenting in ureteric obstruction

causes of pain and other symptoms should be identified and treated appropriately.

Disease specific causes of pain include:

  • Underlying disease e.g. polycystic kidney disease, diabetic neuropathy
  • Renal disease and its treatment e.g. calciphylaxis (tissue ischaemia due to calcification of tissue and small arteries in dialysis patients); ischaemic neuropathies due to A-V fistulae; peritonitis due to peritoneal dialysis

First line: Morphine remains the drug of choice

Stage 1

>90 mL/min

Normal renal function

Stage 2

60–89 mL/min

Mildly reduced renal function

Stage 3

30–59 mL/min

Moderately reduced renal function

Stage 4

15–29 mL/min

Severely reduced renal function

Stage 5

<15 mL/min

Very severe or ESRD

eGFR estimated glomerular filtration rate


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.