Acute kidney injury is usually caused by medication toxicity, infection, urinary obstruction, or metabolic diseases. Chronic kidney disease (CKD) has a protracted disease trajectory. It is usually secondary to other disease processes such as hypertension, diabetes, lupus, or vascular disorders. Dialysis should be considered as part of the plan of care if it is consistent with the patient's goals of care. Palliative care should be initiated early in the disease process to minimize symptomatology. End-of-life care should be discussed when the burden of treatment outweighs the benefit or when it is consistent with the patient's goals. This chapter helps the nurse to differentiate between acute and chronic renal disease, explain the sequelae of CKD, and identify hospice admission criteria for CKD. End-of-life care for patients who have end-stage renal disease is dependent on a complex series of decisions by the patient and his or her family regarding treatment choices.