The components of palliative care in end-stage renal disease (ESRD) include pain and symptom management, advance care planning, psychosocial and spiritual support, and ethical issues in dialysis. End-of-life care is not synonymous with, but rather a subset of palliative care. Advance care planning occurs within the patient-family relationship and is a dynamic process that prepares for death, strengthens interpersonal relationships, and allows a patient to achieve control over his or her life. It is incumbent upon dialysis care providers to include advance care planning in overall care plans for their patients. Factors contributing to the failure of advance care planning in ESRD patients will be discussed, as will hospice and ESRD, and opportunities for bereavement programs.