Randomised Controlled Trial of Integrated Kidney Supportive Care in End Stage Kidney Disease

Background Kidney failure is linked to a substantial symptom burden and diminished quality of life (QoL). The incorporation of kidney supportive care (KSC) and advance care planning (ACP) into routine nephrology practices could enhance patient-centred outcomes; however, data from developing countries are scarce. This study evaluated the effects of KSC versus standard care on quality of life, symptom burden, and ACP engagement in kidney failure. Methods This randomised controlled trial was conducted at a tertiary care hospital in India (June 2023–June 2025) with ethics approval (IEC-214/2021) and CTRI registration (CTRI/2021/06/034179). Adult patients with kidney failure were randomised using block randomisation to receive either integrated kidney supportive care (KSC) or conventional care. Outcomes, including quality of life, symptom burden, and ACP engagement, were assessed at baseline and at 2, 4, and 6 months using the ESAS-r Renal, EQ-5D-5L, and an advance care planning questionnaire. Results Patients in the intervention group showed significant improvements across multiple domains, with QoL scores increasing markedly (p < 0.01) and symptom burden decreasing significantly (p < 0.01) compared with baseline and the control group. Additionally, the patients' willingness to engage in ACP discussions and document increased substantially in the KSC group, which was accompanied by a significantly higher rate of CPR refusal and a reduced willingness for ventilator or ICU admission (p < 0.01). Conclusion Integrated KSC improves quality of life, reduces symptom burden, and enhances ACP engagement. These findings support integrating structured KSC into routine kidney care in developing settings.