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Nalankilli K, Stallworthy E, Ducharlet K, Hole BD, O'Hara DV, Agarwal N, Snead CM, Caskey FJ, Smyth B. Treatment of insomnia, restless legs, cramps, and pain associated with chronic kidney disease: results from a multinational survey of kidney supportive care practice. BMC Nephrol 2025; 26:204. [PMID: 40269733 PMCID: PMC12016115 DOI: 10.1186/s12882-025-04107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 04/04/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Kidney failure is associated with a high symptom burden, yet few studies describe real-world management approaches. METHODS Kidney care units in Australia, New Zealand (NZ) and the United Kingdom (UK) were surveyed regarding their pharmacological treatment of a range of common symptoms affecting those with kidney failure. The present report describes the results for insomnia, restless legs syndrome (RLS), cramps, and pain. Variation in responses was described using normalised generalised variance (NGV), resulting in a score from 1 (most diverse) to 0 (least diverse). RESULTS One hundred and twelve (of 171 contacted) kidney units responded, including 56 units in Australia (50%), 7 in NZ (6%), and 49 in the UK (44%). Diversity of practice was highest for insomnia (mean NGV 0.95, range 0.93-0.98), where melatonin was the leading first-line agent (38%), followed by zolpidem and zopiclone (29%). Diversity of practice was lowest for RLS (mean NGV 0.66, range 0.30-0.99), owing to widespread use of iron replacement as first line (69%), gabapentinoids (45%), and dopamine agonists (37%). Diversity of practice was moderate for neuropathic pain (mean NGV 0.71, range 0.44-0.93), cramps (mean NGV 0.72, range 0.48-0.97), and opioids (mean NGV 0.88, range 0.75-0.97). Numerous significant between-country differences in treatment preferences were noted. CONCLUSIONS There is wide variation in treatment approaches to common symptoms affecting people living with advanced CKD or kidney failure, both within and between countries, indicating a need for evidence-based guidelines and further randomised studies to inform practice. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
| | | | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Barnaby D Hole
- Population Health Sciences, University of Bristol, Bristol, UK
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service, Bristol, UK
| | - Daniel V O'Hara
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Neeru Agarwal
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | | | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
- Department of Renal Medicine, St George Hospital, Kogarah, Australia.
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Mantilla-Manosalva N, Guadarrama S, Bedoya-Muñoz LJ, Giraldo-Moreno S, Cuellar-Valencia L, Iriarte-Aristizábal MF, León MX, Mendoza-Montenegro FA, Correa-Morales JE. Pharmacological Treatment for Dialysis-Related Muscle Cramps: A Systematic Review. Semin Dial 2024; 37:415-423. [PMID: 39155056 DOI: 10.1111/sdi.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Patients with end-stage renal disease undergoing dialysis suffer from muscle cramps, a prevalent and burdensome symptom for which there is a paucity of efficient and safe treatments. AIM What is the efficacy and safety of pharmacological interventions for the treatment of dialysis-related muscle cramps? DESIGN A systematic review was conducted in OVID, CINAHL, PubMed, Web of Science, and Central Cochrane databases up to August 25, 2023. DATA SOURCES Experimental studies reporting on a pharmacological intervention for the treatment of dialysis-related muscle cramps were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the studies quality was assessed with the RoB2 tool. RESULTS A total of 4660 studies were retrieved, and 13 articles were included. The studies reported on nine interventions: vitamin C, vitamin E, vitamin K2, vitamin B7, dextrose solutions, gabapentin, sodium chloride, creatine monohydrate, and L-carnitine. The studies testing L-carnitine and creatine monohydrate were the only ones deemed to have a low risk of bias. Side effects were reported in only two trials, consisting primarily of gastrointestinal discomfort and hyperglycemia. Vitamins C and E are the two most studied interventions that showed positive results in reducing the frequency, severity, and duration of dialysis-related muscle cramps. L-carnitine is a promising intervention that warrants further investigation. CONCLUSION Our review consolidates the existing evidence, elucidating the range of treatments along with their potential benefits and limitations. Future studies should uphold high-quality standards, incorporate patient-reported outcomes, and utilize well-defined, robust samples to improve patient care.
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Affiliation(s)
- Nidia Mantilla-Manosalva
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Santiago Guadarrama
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Lennis Jazmin Bedoya-Muñoz
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Laura Cuellar-Valencia
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - María Fernanda Iriarte-Aristizábal
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Juan Esteban Correa-Morales
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá, Colombia
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Nitola-Mendoza L, Sánchez-Cárdenas M, Rodriguez-Chitiva N, Mora Gutiérrez JM, Rodriguez-Pena R, Romero-González G, Bleda Pérez M, Cuenca Casbas P, Calsina-Berna A, Álvaro-Pardo M, Granados Casas V, Garrido Ballart P, Beroiz Groh P, Bover J, Miralles Basseda R, Leiva-Santos JP, Alonso-Babarro A, Julià-Torras J. Nomenclature in Palliative and Kidney Supportive Care: Not Just at the End-of-Life. Nefrologia 2024; 44:475-485. [PMID: 39127583 DOI: 10.1016/j.nefroe.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 08/12/2024] Open
Abstract
The multidimensional view of disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide a multidisciplinary approach tailored to the needs of each individual. Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute situations, potentially irreversible or interventions that do not improve life expectancy. To ensure excellence in care, it is important to assess indicators of palliative care and kidney support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families. Palliative and kidney care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.
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Affiliation(s)
| | | | - Néstor Rodriguez-Chitiva
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - José María Mora Gutiérrez
- Nephrology Department, Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Rosely Rodriguez-Pena
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain; International Renal Research Institute of Vicenza, Vicenza, Italy
| | | | | | - Agnès Calsina-Berna
- Palliative Care Department, Catalan Institute of Oncology, Badalona, Spain; Chair of Palliative Care, Medical School, Universitat de Vic-Universitat Central de Catalunya, Spain
| | | | | | | | - Patricia Beroiz Groh
- Geriatrics Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Jordi Bover
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | | | | | | | - Joaquim Julià-Torras
- Palliative Care Department, Catalan Institute of Oncology, Badalona, Spain; Faculty of Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
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Moss AH, Harbert G, Aldous A, Anderson E, Nicklas A, Lupu DE. Pathways Project Pragmatic Lessons Learned: Integrating Supportive Care Best Practices into Real-World Kidney Care. KIDNEY360 2023; 4:1738-1751. [PMID: 37889550 PMCID: PMC10758509 DOI: 10.34067/kid.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
Key Points A multisite quality improvement project using the Institute for Healthcare Improvement learning collaborative structure helped kidney care teams identify seriously ill patients and implement supportive care best practices. Helpful approaches included needs assessment, Quality Assurance and Performance Improvement tools, peer exchange, clinician role modeling, data feedback, and technical assistance. Dialysis center teams tailored implementation of best practices into routine dialysis workflows with nephrologist prerogative to delegate goals of care conversations to nurse practitioners and social workers. Background Despite two decades of national and international guidelines urging greater availability of kidney supportive care (KSC), uptake in the United States has been slow. We conducted a multisite quality improvement project with ten US dialysis centers to foster implementation of three KSC best practices. This article shares pragmatic lessons learned by the project organizers. Methods The project team engaged in reflection to distill key lessons about what did or did not work in implementing KSC. Results The seven key lessons are (1 ) systematically assess KSC needs; (2 ) prioritize both the initial practices to be implemented and the patients who have the most urgent needs; (3 ) use a multifaceted approach to bolster communication skills, including in-person role modeling and mentoring; (4 ) empower nurse practitioners and social workers to conduct advance care planning through teamwork and warm handoffs; (5 ) provide tailored technical assistance to help sites improve documentation and electronic health record processes for storing advance care planning information; (6 ) coach dialysis centers in how to use required Quality Assurance and Performance Improvement processes to improve KSC; and (7 ) implement systematic approaches to support patients who choose active medical management without dialysis. Conclusions Treatment of patients with kidney disease is provided in a complex system, especially when considered across the continuum, from CKD to kidney failure on dialysis, and at the end of life. Even among enthusiastic early adopters of KSC, 18 months was insufficient time to implement the three prioritized KSC best practices. Concentrating on a few key practices helped teams focus and see progress in targeted areas. However, effect for patients was attenuated because federal policy and financial incentives are not aligned with KSC best practices and goals. Clinical Trial registry name and registration number Pathways Project: KSC, NCT04125537 .
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Affiliation(s)
- Alvin H. Moss
- Sections of Nephrology and Palliative Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Annette Aldous
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Elizabeth Anderson
- Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina
| | - Amanda Nicklas
- School of Nursing, George Washington University, Washington, DC
| | - Dale E. Lupu
- School of Nursing, George Washington University, Washington, DC
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Li X, Luo JK. Perceptions and attitudes of kidney supportive care among elderly patients with advanced chronic kidney disease and dialysis healthcare professionals in China: a qualitative study. BMC Nephrol 2023; 24:316. [PMID: 37884858 PMCID: PMC10604377 DOI: 10.1186/s12882-023-03372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Kidney supportive care (KSC) represents a novel approach wherein a multidisciplinary team of nephrology experts offers active symptom management, advance care planning, shared decision-making, conservative treatment, and end-of-life care. This study is aimed at providing comprehensive insights and evaluations regarding the understanding and perspectives of Chinese healthcare professionals, including nephrologists and dialysis nurses, as well as elderly individuals aged 60 and above who are afflicted with chronic kidney disease. The primary goal is to furnish substantial information support for a better comprehension of KSC within the Chinese context, with the ultimate aim of facilitating its effective implementation in this region. METHODS Employing a phenomenological framework, this qualitative research generated data using semi-structured interviews with 18 elderly patients diagnosed with advanced chronic kidney disease and 10 healthcare professionals across two Class III Grade A medical institutions. The Colaizzi's analytical method was utilized for coding and analyzing the interview data. RESULTS Distinct interviews were executed with patients and healthcare professionals to delineate specific themes for each group. For elderly dialysis patients, the following themes were formed: (1) Lack of understanding of KSC; (2) Concerns of how KSC is perceived; and (3) Perceived benefits of KSC. Within the healthcare professionals cohort, two salient themes emerged: (1) Prospective clinical merits of KSC ; and (2) Mltiple difficulties encountered. CONCLUSIONS This study goes some way in furnishing a holistic understanding of perceptions surrounding KSC among elderly patients undergoing dialysis and healthcare professionals in China. The overarching Chinese cultural ethos poses substantial challenges to the widespread assimilation of KSC. While healthcare professionals advocate for KSC, there remains a limit in the patients' comprehension of this therapeutic paradigm. There is a compelling imperative to cultivate this strategy, grounded in the prevailing medical landscape.
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Affiliation(s)
- Xue Li
- Beijing Friendship Hospital, Nursing Department, Beijing Friendship Hospital, Capital Medical University, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Jin Kai Luo
- Beijing Friendship Hospital, Nursing Department, Beijing Friendship Hospital, Capital Medical University, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China.
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Ducharlet K, Weil J, Gock H, Philip J. How Do Kidney Disease Clinicians View Kidney Supportive Care and Palliative Care? A Qualitative Study. Am J Kidney Dis 2022; 81:583-590.e1. [PMID: 36565800 DOI: 10.1053/j.ajkd.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Kidney supportive care (KSC) is a developing area in medicine that integrates the expertise of kidney and palliative care practitioners to improve symptoms and quality of life for people with advanced kidney disease. The intersection of the practical aspects of KSC (including care activities and clinical referrals) with palliative and end-of-life care (EOLC) are largely unknown. The aim of this study was to explore kidney disease clinicians' experiences of KSC, palliative care, and EOLC. STUDY DESIGN An exploratory qualitative study using semistructured focus groups. SETTING & PARTICIPANTS Kidney disease clinicians (18 physicians, 3 trainees, and 33 kidney disease nurses) from 5 public hospitals were recruited across Victoria, Australia. ANALYTICAL APPROACH Thematic analysis of focus group transcripts. RESULTS The 2 overarching themes highlighted by clinicians were their perception that their health care systems insufficiently addressed the needs of people with advanced kidney disease, as well as their aspirations to develop KSC services to improve health care experiences. Three subthemes were identified related to limitations in health care systems: (1) variation in the clinical scope of KSC, (2) limited integration of palliative care, and (3) experiences of challenging and compromised provision of EOLC. The second theme described aspirations for future KSC services to be more inclusive, seamless, and collaborative across health care providers with capacity to respond to meet changing palliative care needs. LIMITATIONS Findings may not be transferable to contexts outside of Victoria, Australia; data were collected in 2017-2018 and may not reflect current or future experiences. CONCLUSIONS Kidney clinicians described systemic challenges and compromises in care experiences and the need for development of KSC services. They expressed that this development would require a consistent and systematic approach that integrates palliative care and embeds KSC as part of kidney health service delivery.
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Affiliation(s)
- Kathryn Ducharlet
- Department of Palliative Medicine, St Vincent's Hospital Melbourne; Department of Nephrology, St Vincent's Hospital Melbourne; Department of Medicine, University of Melbourne, Melbourne, Australia; Eastern Health Integrated Renal Services, Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Jennifer Weil
- Department of Palliative Medicine, St Vincent's Hospital Melbourne; Department of Nephrology, St Vincent's Hospital Melbourne; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Hilton Gock
- Department of Nephrology, St Vincent's Hospital Melbourne; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jennifer Philip
- Department of Palliative Medicine, St Vincent's Hospital Melbourne; Department of Medicine, University of Melbourne, Melbourne, Australia
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