Chronic kidney disease (CKD) is a life-limiting illness, and people who require dialysis remain under the care of the renal team for the duration of their lives. The dialysis population is ageing and increasingly frail. In addition, many people with CKD have co-existing conditions, for instance, diabetes and/or cardiovascular disease, as well as those associated with ageing such as reduced mobility, incontinence and memory loss. Consequently, as with the general population, palliative care for people with CKD represents a spectrum. Due to the complexity of needs of the dialysis population and the uncertainty of their illness trajectory, palliative care can often be initiated months or even years before their actual death. Most people on dialysis die from causes other than kidney disease, typically cardiovascular complications. A number will die suddenly, but most will experience a gradual decline over months or years, punctuated with exacerbations or complications of other conditions and/or acute illnesses.