1
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Davison SN, Pommer W, Brown MA, Douglas CA, Gelfand SL, Gueco IP, Hole BD, Homma S, Kazancıoğlu RT, Kitamura H, Koubar SH, Krause R, Li KC, Lowney AC, Nagaraju SP, Niang A, Obrador GT, Ohtake Y, Schell JO, Scherer JS, Smyth B, Tamba K, Vallath N, Wearne N, Zakharova E, Zúñiga C, Brennan FP. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure. Kidney Int 2024; 105:35-45. [PMID: 38182300 DOI: 10.1016/j.kint.2023.10.001] [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: 06/07/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 01/07/2024]
Abstract
Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.
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Affiliation(s)
- Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Wolfgang Pommer
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Claire A Douglas
- Department of Renal Medicine, Ninewells Hospital, Dundee, Scotland, UK
| | - Samantha L Gelfand
- Division of Renal (Kidney) Medicine, Department of Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Irmingarda P Gueco
- Section of Nephrology, The Medical City, Pasig City, National Capital Region, Philippines
| | - Barnaby D Hole
- Department of Population Health, University of Bristol, Bristol, UK
| | - Sumiko Homma
- Department of Nephrology, Koga Red Cross Hospital, Koga, Ibaraki, Japan
| | - Rümeyza T Kazancıoğlu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Harumi Kitamura
- Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rene Krause
- Division of Interdisciplinary Palliative Care and Medicine, Department of Family Community and Emergency Care, University of Cape Town, Cape Town, South Africa
| | - Kelly C Li
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Aoife C Lowney
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland; Department of Palliative Medicine, University College Cork, Cork, Ireland
| | - Shankar P Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University, Dakar, Senegal
| | - Gregorio T Obrador
- Department of Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | | | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Scherer
- Department of Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Kaichiro Tamba
- Division of Palliative Care Medicine, Juchi Medical School University Hospital, Tochigi, Japan
| | - Nandini Vallath
- Department of Palliative Medicine, St Johns National Academy of Health Sciences, Bengaluru, India
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Carlos Zúñiga
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Frank P Brennan
- Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany; Department of Renal Medicine, St George Hospital, Kogarah, Australia
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2
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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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3
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Al Maraee G, Vangaveti V, Mallett A. Characterising patients and clinician experiences in comprehensive conservative care for kidney failure in Northern Queensland. Intern Med J 2023; 53:1819-1825. [PMID: 36372949 DOI: 10.1111/imj.15977] [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: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Comprehensive conservative care (CCC) is an emerging treatment option in kidney failure (KF), but its implementation has been restricted by a limited understanding of KF populations, outcomes and clinician experiences. AIMS This pilot study aimed to investigate the characteristics of patients who are opting for (CCC) in North Queensland, Australia. It also aimed to highlight clinician factors impacting treatment discussions. METHODS It was an observational study facilitated through an online cross-sectional survey to nephrologists, nephrology advanced trainees and nurse practitioners working across North Queensland. RESULTS Study participants disagreed with the statement that patients commencing dialysis are more likely to have cardiac co-morbidities (46.7%), diabetes (40.0%), stroke (60.0%), liver disease (60.0%), chronic lung disease (53.3%), cognitive impairment (60.0%) and use of mobility aids (80.0%) than those commencing CCC. Conversely, they agreed that patients commencing dialysis are more likely to be independent (66.7%) and living in their private residence (40.0%). The median frailty score in patients choosing dialysis was 3.0 (interquartile range (IQR) 2.8-3.3), while that of patients selecting CCC was 4.5 (IQR 3.8-7.0). Our participants were aware of at least one clinical prognostication tool, and the one most frequently used was the 'Surprise Question' (46.2%, n = 6). Overall, our participants demonstrated low confidence (median 8.0%, IQR 6.0-8.0%) in facilitating CCC discussions. CONCLUSION Patients who are highly co-morbid and frail and have functional impairment are suitable candidates for CCC. More focus needs to be placed on objective prognostication of patients and the upskilling of clinicians to advocate for, and deliver, CCC.
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Affiliation(s)
- Gheed Al Maraee
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Andrew Mallett
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Gelfand SL, Hentschel DM. Dialysis Access Considerations in Kidney Palliative Care. Semin Nephrol 2023; 43:151397. [PMID: 37579517 DOI: 10.1016/j.semnephrol.2023.151397] [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] [Indexed: 08/16/2023]
Abstract
In this review, we discuss common challenges at the interface between dialysis access planning, prognostication, and patient-centered decision making. Particularly for patients whose survival benefit from dialysis is attenuated by advanced age or other serious illness, knowing the potential complications and anticipated frequency of access procedures is essential for patients and families to be able to conceptualize what life on dialysis will look like. Although starting dialysis with a functioning graft or fistula is associated with reduced infection rates, mortality, hospitalizations, and cost compared with a central venous catheter, these benefits must be weighed against the chance that early access placement in an elderly or seriously ill patient is an unnecessary surgery because the chronic kidney disease never progresses, the patient dies before developing an indication to start dialysis, or, the patient prefers conservative kidney management over dialysis. Kidney palliative care is a growing subspecialty of nephrology focused on helping seriously ill patients navigate complex medical decisions, and may be useful for intensive goals-of-care discussions about treatment and access options for patients with limited anticipated survival because of age or other serious illness.
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Affiliation(s)
- Samantha L Gelfand
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston MA; Department of Medicine, Division of Palliative Care, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Interventional Nephrology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Dirk M Hentschel
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston MA; Department of Medicine, Interventional Nephrology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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5
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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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Greenham L, Bennett PN, Dansie K, Viecelli AK, Jesudason S, Mister R, Smyth B, Westall P, Herzog S, Brown C, Handke W, Palmer SC, Caskey FJ, Couchoud C, Simes J, McDonald SP, Morton RL. The Symptom Monitoring with Feedback Trial (SWIFT): protocol for a registry-based cluster randomised controlled trial in haemodialysis. Trials 2022; 23:419. [PMID: 35590395 PMCID: PMC9118566 DOI: 10.1186/s13063-022-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney failure prevalence is increasing worldwide. Haemodialysis, peritoneal dialysis or kidney transplantation are undertaken to extend life with kidney failure. People receiving haemodialysis commonly experience fatigue, pain, nausea, cramping, itching, sleeping difficulties, anxiety and depression. This symptom burden contributes to poor health-related quality of life (QOL) and is a major reason for treatment withdrawal and death. The Symptom monitoring WIth Feedback Trial (SWIFT) will test the hypothesis that regular symptom monitoring with feedback to people receiving haemodialysis and their treating clinical team can improve QOL. METHODS We are conducting an Australia and New Zealand Dialysis and Transplant (ANZDATA) registry-based cluster randomised controlled trial to determine the clinical- and cost-effectiveness at 12 months, of 3-monthly symptom monitoring using the Integrated Palliative Outcome Scale-Renal (IPOS-Renal) survey with clinician feedback, compared with usual care among adults treated with haemodialysis. Participants complete symptom scoring using a tablet, which are provided to participants and to clinicians. The trial aims to recruit 143 satellite haemodialysis centres, (up to 2400 participants). The primary outcome is change in health-related QOL, as measured by EuroQol 5-Dimension, 5-Level (EQ-5D-5L) instrument. Secondary outcomes include overall survival, symptom severity (including haemodialysis-associated fatigue), healthcare utilisation and cost-effectiveness. DISCUSSION SWIFT is the first registry-based trial in the Australian haemodialysis population to investigate whether regular symptom monitoring with feedback to participants and clinicians improves QOL. SWIFT is embedded in the ANZDATA Registry facilitating pragmatic recruitment from public and private dialysis clinics, throughout Australia. SWIFT will inform future collection, storage and reporting of patient-reported outcome measures (PROMs) within a clinical quality registry. As the first trial to rigorously estimate the efficacy and cost-effectiveness of routine PROMs collection and reporting in haemodialysis units, SWIFT will provide invaluable information to health services, clinicians and researchers working to improve the lives of those with kidney failure. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001061921 . Registered on 16 October 2020.
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Affiliation(s)
- Lavern Greenham
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA.,University of South Australia, Adelaide, SA, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Andrea K Viecelli
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rebecca Mister
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Portia Westall
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Samuel Herzog
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | | | | | | | - Cecile Couchoud
- Renal Epidemiology and Information Network (REIN), Agence de la Biomédecine, Saint-Denis, Paris, France
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
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7
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Chen JHC, Lim WH, Howson P. Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice. Nephrology (Carlton) 2022; 27:551-565. [PMID: 35201646 PMCID: PMC9315017 DOI: 10.1111/nep.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Dialysis withdrawal has become an accepted treatment option for patients with kidney failure and is one of the leading causes of death in patients receiving dialysis in high-income countries. Despite its increasing acceptance, dialysis withdrawal currently lacks a clear, consistent definition. The processes and outcomes of dialysis withdrawal have wide temporal and geographical variability, attributed to dialysis patient selection, influence from cultural, religious and spiritual beliefs, and availability of kidney replacement therapy and conservative kidney management. As a complex, evolving process, dialysis withdrawal poses an enormous challenge for clinicians and healthcare teams with various limitations precluding a peaceful and smooth transition between active dialysis and end-of-life care. In this review, we examine the current definitions of dialysis withdrawal, the temporal and geographical patterns of dialysis withdrawal, international barriers in the decision-making process (including dialysis withdrawal during the COVID-19 pandemic), and gaps in the current dialysis withdrawal recommendations for clinical consideration and future studies.
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Affiliation(s)
- Jenny H C Chen
- Faculty of Medicine, University of Wollongong, Wollongong, Australia.,Wollongong Hospital, Wollongong, Australia
| | - Wai H Lim
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.,Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Prue Howson
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia
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8
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Chen HC, Wu CY, Hsieh HY, He JS, Hwang SJ, Hsieh HM. Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:85. [PMID: 35010349 PMCID: PMC8751193 DOI: 10.3390/ijerph19010085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. METHOD We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. RESULTS Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43-8.70) or sepsis (OR 1.62, 95% CI 1.08-2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56-8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80-9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0-28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. CONCLUSION Given the "Patient Right to Autonomy Act" implemented in Taiwan in 2019 to promote the concept of a "good quality of death", this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.
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Affiliation(s)
- Hung-Cheng Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (H.-Y.H.)
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Hui-Ya Hsieh
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (H.-Y.H.)
| | - Jiun-Shiuan He
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Hui-Min Hsieh
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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9
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Rao IR, Vallath N, Anupama YJ, Gupta KL, Rao KS. Decision-making around Commencing Dialysis. Indian J Palliat Care 2021; 27:S6-S10. [PMID: 34188372 PMCID: PMC8191747 DOI: 10.4103/ijpc.ijpc_61_21] [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: 02/22/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022] Open
Abstract
The decision regarding dialysis initiation is complex. Awareness that renal replacement therapy should not be regarded as default therapy for every patient with advanced renal failure is necessary. Decision to initiate dialysis and modality should be individualized in a shared decision-making process involving the treating nephrologist and the patient. Patients should receive predialysis education early in the course of chronic kidney disease so as to help prepare them well in advance for this eventuality. Withholding dialysis may be a reasonable option in a certain subset of patients, especially elderly patient with multiple co-morbid illnesses. Comprehensive conservation care should be offered in all patients where the decision to not dialyze is taken.
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Affiliation(s)
- Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nandini Vallath
- Division of Palliative Care, National Cancer Grid, India.,Department of Palliative Care, BARC Hospital, Mumbai, Maharashtra, India.,Department of Palliative Care and Division of Medical Humanities, KEM Hospital, Mumbai, Maharashtra, India
| | - Y J Anupama
- Department of Nephrology, Nanjappa Hospital, Shivamogga, Karnataka, India
| | - Krishan Lal Gupta
- Department of Nephrology and Renal Transplantation, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krithika S Rao
- Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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10
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Sabih AH, Laube R, Strasser SI, Lim L, Cigolini M, Liu K. Palliative medicine referrals for hepatocellular carcinoma: a national survey of gastroenterologists. BMJ Support Palliat Care 2021:bmjspcare-2020-002807. [PMID: 33737287 DOI: 10.1136/bmjspcare-2020-002807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Palliative care (PC) service involvement for hepatocellular carcinoma (HCC) patients is suboptimal and little is known about the underlying reasons for this. We aimed to study clinicians' experience and attitudes towards PC in HCC. METHODS A nationwide survey was conducted of consultants/trainees recruited from the Gastroenterological Society of Australia membership directory. Clinician demographics, experience and attitudes towards PC use for HCC patients were collected. RESULTS There were 160 participants. Most attended weekly multidisciplinary team meetings (MDTM, 60%) and had no formal PC training (71%). MDTM with PC attendance was reported by 12%. Rates of PC referral increased incrementally from BCLC 0/A to D patients but were not universal even in advanced (46%) or terminal (87%) stages. Most acknowledged PC patient discussions occurred too late (61%). Those with prior PC training were more likely to refer BCLC 0/A and B patients for early PC. Referral rates for outpatient PC were higher in respondents who attended MDTM with PC present across all BCLC stages. PC service was rated good/very good by 70%/81% for outpatients/inpatients. Barriers to PC referral included clinician-perceived negative patient associations with PC (83%), clinician-perceived patient/caregiver lack of acceptance (81%/77%) and insufficient time (70%). CONCLUSIONS PC referral for HCC patients is not universal and occurs late even in late-stage disease. Prior PC training and/or PC presence at MDTM positively influences referral practices. Barriers to PC referral are not related to quality of PC services but rather to clinician-perceived patients' negative reactions to or lack of acceptance of PC.
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Affiliation(s)
- Abdul Hamid Sabih
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Robyn Laube
- Department of Gastroenterology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lynn Lim
- Palliative Care Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Maria Cigolini
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Palliative Care Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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11
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Chia XX, Johnston R, Aggarwal R, Huynh T, Notaras S, Zekanovic D, Gordon K, Sasongko V, Makris A. Renal supportive care programs: An observational study assessing impact on hospitalization and survival outcomes. Nephrology (Carlton) 2021; 26:522-529. [PMID: 33650168 DOI: 10.1111/nep.13869] [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: 12/01/2020] [Revised: 02/14/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
AIM Renal supportive care (RSC) programs are used to manage non-dialysis end-stage kidney disease (ESKD) patients. The aim of this study was to analyse the impact of RSC programs on hospitalization and survival outcomes in these patients. METHODS A retrospective, single-centre observational cohort study of non-dialysis ESKD patients was undertaken. Hospitalizations and survival from eGFR≤15 ml/min was compared between patients managed in an RSC program (RSC group) and patients receiving standard conservative therapy (non-RSC group). Local databases, physician letters and electronic medical records were used for data collection. Prevalent patients from 2013 to 2017 with eGFR ≤15 ml/min were included. Cox proportion hazard testing and generalized linear modelling was undertaken to adjust for confounders. RESULTS A total of 172 patients were included (95 RSC; 75 non-RSC). The median age was 82 years [IQR 78-85], 46% were male, the median Charlson-comorbidity Index was 5 [IQR 4-7]. The RSC group had significantly lowered haemoglobin level (102 g/L vs. 111 g/L) and fewer English-speakers (34% vs. 44%). RSC was associated with the decreased number of days in hospital per year (estimated means 46.6 days [95% CI 21-67] vs. 83.2 days [95%CI 60.5-105.8]; p = .01) and decreased number of hospital admissions per year (estimated means 5.4 [95%CI 2.1-8.8] vs. 12.3 [95%CI 8.2-16.4]; p = .01) compared with non-RSC. Median overall survival from eGFR≤15 in the entire cohort was 735 days, with no significant difference between RSC and non-RSC groups (p = .9), both unadjusted and adjusted for confounders. CONCLUSION RSC programs can significantly decrease the number and length of hospitalizations in conservatively managed ESKD patients.
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Affiliation(s)
- Xiu Xian Chia
- Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Rebecca Johnston
- Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Rajesh Aggarwal
- Palliative Care Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.,Department of Medicine, University of New South Wales, Sydney, Australia.,Clinical Affiliate, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Thang Huynh
- Palliative Care Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.,Department of Medicine, University of New South Wales, Sydney, Australia.,Clinical Affiliate, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Stephanie Notaras
- Department of Medicine, Western Sydney University, Sydney, Australia.,Dietetics Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Dragana Zekanovic
- Social Work Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Katrina Gordon
- Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Victoria Sasongko
- Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia
| | - Angela Makris
- Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.,Department of Medicine, University of New South Wales, Sydney, Australia.,Department of Medicine, Western Sydney University, Sydney, Australia
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12
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Lunney M, Bello AK, Levin A, Tam-Tham H, Thomas C, Osman MA, Ye F, Bellorin-Font E, Benghanem Gharbi M, Ghnaimat M, Htay H, Cho Y, Jha V, Ossareh S, Rondeau E, Sola L, Tchokhonelidze I, Tesar V, Tungsanga K, Kazancioglu RT, Wang AYM, Yang CW, Zemchenkov A, Zhao MH, Jager KJ, Jindal KK, Okpechi IG, Brown EA, Brown M, Tonelli M, Harris DC, Johnson DW, Caskey FJ, Davison SN. Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide. Clin J Am Soc Nephrol 2021; 16:79-87. [PMID: 33323461 PMCID: PMC7792657 DOI: 10.2215/cjn.09070620] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Global Kidney Health Atlas is an ongoing initiative of the International Society of Nephrology that aims to monitor and evaluate the status of global kidney care worldwide. This study reports on findings from the 2018 Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of conservative kidney management. RESULTS Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery. CONCLUSIONS Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Tam-Tham
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chandra Thomas
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mohamed A. Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Mohammad Ghnaimat
- Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia,Translational Research Institute, Brisbane, Queensland, Australia,Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France,Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France and Sorbonne Université, Paris, France
| | - Laura Sola
- Dialysis Unit, Centro de Asistencia del Sindicato Médico del Uruguay - Institución de Asistencia Medica Privada de Profesionales (CASMU-IAMPP), Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Kriang Tungsanga
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand,Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | | | - Angela Yee-Moon Wang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alexander Zemchenkov
- Department of Internal Diseases, Clinical Pharmacology, and Nephrology, North-Western State Medical University named after I. I. Mechnikov, St. Petersburg, Russia,Department of Nephrology and Dialysis, Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China,Key Lab of Renal Disease, Ministry of Health of China, Beijing, China,Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China,Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Kitty J. Jager
- European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Kailash K. Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Edwina A. Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, England
| | - Mark Brown
- Department of Renal Medicine, St George Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada,Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David C. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia,Translational Research Institute, Brisbane, Queensland, Australia,Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fergus J. Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom and Population Health Sciences, University of Bristol, Bristol, United Kingdom,Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Sara N. Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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13
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Chiu HHL, Murphy-Burke DM, Thomas SA, Melnyk Y, Kruthaup-Harper AL, Dong JJ, Djurdjev O, Saunders S, Levin A, Karim M, Hargrove GM. Advancing Palliative Care in Patients With CKD: From Ideas to Practice. Am J Kidney Dis 2020; 77:420-426. [PMID: 33181264 DOI: 10.1053/j.ajkd.2020.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/06/2020] [Indexed: 11/11/2022]
Abstract
A palliative approach to care focuses on what matters most to patients with life-limiting illness, including chronic kidney disease (CKD). Despite recent publication of related clinical practice guidelines in nephrology, there is limited information about how to practically implement these recommendations. In this Perspective, we describe our experience integrating a palliative approach within routine care of patients with CKD glomerular filtration rate categories 4 and 5 (G4-G5) across a provincial kidney care network during the past 15 years. The effort was led by a multidisciplinary group, tasked with building capacity and developing tools and resources for practical integration within a provincial network structure. We used an evidence-based framework that includes recommendations for 4 pillars of palliative care to guide our work: (1) patient identification, (2) advance care planning, (3) symptom assessment and management, and (4) caring of the dying patient and bereavement. Activities within each pillar have been iteratively implemented across all kidney care programs using existing committees and organizational structures. Key quality indicators were used to guide strategic planning and improvement. We supported culture change through the use of multiple strategies simultaneously. Altogether, we established and integrated palliative care activities into routine CKD G4-G5 care across the continuum from nondialysis to dialysis populations.
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Affiliation(s)
- Helen H-L Chiu
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Donna M Murphy-Burke
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah A Thomas
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuriy Melnyk
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Janghu James Dong
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ognjenka Djurdjev
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sushila Saunders
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adeera Levin
- BC Renal, Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Faculty of Medicine, The University of British Columbia, Victoria, British Columbia, Canada
| | - Mohamud Karim
- Fraser Health Authority, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Faculty of Medicine, The University of British Columbia, Victoria, British Columbia, Canada
| | - Gaylene M Hargrove
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Victoria, British Columbia, Canada; Island Health Authority, British Columbia, Canada
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14
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Bello AK, Brown M, Caskey FJ, Donner JA, Liew A, Muller E, Naicker S, O'Connell PJ, Filho RP, Vachharajani T. Strategic plan for integrated care of patients with kidney failure. Kidney Int 2020; 98:S117-S134. [PMID: 33126957 DOI: 10.1016/j.kint.2020.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; Manipal Academy of Higher Education (MAHE), Manipal, Kamataka, India
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Tushar Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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15
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Martin DE, Harris DCH, Jha V, Segantini L, Demme RA, Le TH, McCann L, Sands JM, Vong G, Wolpe PR, Fontana M, London GM, Vanderhaegen B, Vanholder R. Ethical challenges in nephrology: a call for action. Nat Rev Nephrol 2020; 16:603-613. [PMID: 32587403 DOI: 10.1038/s41581-020-0295-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.
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Affiliation(s)
- Dominique E Martin
- School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, Australia.
| | - David C H Harris
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- University of Oxford, Oxford, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Luca Segantini
- International Society of Nephrology, Brussels, Belgium
- European Society for Organ Transplantation - ESOT c/o ESOT, Padova, Italy
| | - Richard A Demme
- Renal Division and Department of Medical Humanities and Bioethics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Thu H Le
- Nephrology Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura McCann
- American Society of Nephrology, Washington, DC, USA
| | - Jeff M Sands
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard Vong
- Center for Ethics, Emory University, Atlanta, GA, USA
| | | | - Monica Fontana
- European Renal Association - European Dialysis and Transplant Association, Parma, Italy
| | - Gerard M London
- Manhes Hospital, Nephrology Department GEPIR, Fleury-Mérogis, France
| | | | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital, Corneel Heymanslaan 10, B9000, Gent, Belgium
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16
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Siriwardana AN, Hoffman AT, Brennan FP, Li K, Brown MA. Impact of Renal Supportive Care on Symptom Burden in Dialysis Patients: A Prospective Observational Cohort Study. J Pain Symptom Manage 2020; 60:725-736. [PMID: 32389605 DOI: 10.1016/j.jpainsymman.2020.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT Symptom burden is a strong predictor of reduced health-related quality of life and survival in patients with end-stage kidney disease. Renal supportive care (RSC) is a comprehensive approach shown to benefit symptoms in nondialysis conservatively managed patients, although its role in dialysis patients has not been reported. OBJECTIVES This study aimed to investigate the impacts of RSC intervention on symptoms in dialysis patients. METHODS Dialysis patients who were referred to an RSC clinic for symptom control between April 2010 and December 2017 were followed prospectively. Symptoms were scored using the Integrated Palliative care Outcomes Scale-Renal Inventory. Change in symptoms was analyzed at three visits and at final RSC visit within the study period. Correlation and linear regression were used to assess for effect modifiers. RESULTS A total of 127 dialysis patients attended the RSC clinic for symptom management. Median age was 74 years, 62% males, median dialysis vintage was 2.2 years, and median-modified Charlson Comorbidity Index was 7. Mean combined physical and emotional symptom score at baseline was 17.5 (SD 9.6), the most overwhelming/severe symptoms being difficulty sleeping (35%), pain (31%), lack of energy (31%), poor mobility (24%), and itch (22%). Eighty patients had follow-up to at least three RSC visits (median 3.1 months). There was significant improvement in combined physical and emotional symptom score during three clinic visits (18.1 vs. 14.2; mean change -3.8; 95% CI -5.7 to -1.9; P < 0.001), with greatest improvement in symptom scores for the five most severe symptoms (each P < 0.001). Follow-up of these 80 patients to final RSC visit (median 13.0 months) showed sustained reduction in mean combined physical and emotional symptom score (18.1 vs. 14.4; mean change -3.7; 95% CI -5.6 to -1.7; P < 0.001). These changes occurred without change in dialysis delivery. CONCLUSION RSC intervention that focuses on symptom control and patient-centered care is associated with improved total and individual symptom burden in dialysis patients. This supports a role for RSC as a management adjunct in these patients.
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Affiliation(s)
- Amanda N Siriwardana
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Anna T Hoffman
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Frank P Brennan
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Kelly Li
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
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17
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Ducharlet K, Philip J, Kiburg K, Gock H. Renal supportive care, palliative care and end-of-life care: Perceptions of similarities, differences and challenges across Australia and New Zealand. Nephrology (Carlton) 2020; 26:15-22. [PMID: 32989844 DOI: 10.1111/nep.13787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/15/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
Renal supportive care (RSC) is an approach integrating nephrology and palliative care to improve quality of life for people with chronic kidney disease (CKD). RSC practice varies across services; therefore, understanding clinicians' perspectives is important to the evolution and definition of RSC. AIM To understand renal clinicians' views and experiences of RSC, palliative care and end-of-life care. METHOD A cross-sectional online survey was undertaken across Australia and New Zealand between February and May 2018. Participants were asked about end-of-life care, RSC, palliative care and an ideal model of RSC. RESULTS Estimated response rate 13% included 382 clinicians; doctors (32%), nurses (68%); of whom 84% access specialist palliative care and 59% RSC. A lack of agreed treatment goals (86%) and late or rushed treatment decision making (85%) was associated with challenging end-of-life experiences. Variable concepts of RSC were described, with RSC being considered the same as: usual care for all CKD patients (40%), conservative (30%) or palliative care (22%). The term RSC was generally distinct from (77%) and more acceptable than palliative care (80%) with preferential RSC referral for symptoms (86% vs 69%, P < .01) and complex treatment decision making (82% vs 58%, P < .01). Aspirations for RSC included improving symptoms and quality of life (89%), with an ideal model comprising: symptom management (98%), improved nephrology and community service integration (96%) and clinician education (94%). CONCLUSION This study revealed challenges for renal clinicians in providing end-of-life care and variation of views and experiences of RSC. It represents opportunities to develop RSC aligned with clinician priorities to improve patient care.
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Affiliation(s)
- Kathryn Ducharlet
- Department of Medicine, Melbourne University, Melbourne, Victoria, Australia.,Department of Nephrology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, Melbourne University, Melbourne, Victoria, Australia.,Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Katerina Kiburg
- Department of Medicine, Melbourne University, Melbourne, Victoria, Australia
| | - Hilton Gock
- Department of Medicine, Melbourne University, Melbourne, Victoria, Australia.,Department of Nephrology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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18
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Tavares APDS, Santos CGDS, Tzanno-Martins C, Barros Neto J, Silva AMMD, Lotaif L, Souza JVL. Kidney supportive care: an update of the current state of the art of palliative care in CKD patients. ACTA ACUST UNITED AC 2020; 43:74-87. [PMID: 32897286 PMCID: PMC8061961 DOI: 10.1590/2175-8239-jbn-2020-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022]
Abstract
Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.
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Affiliation(s)
- Alze Pereira Dos Santos Tavares
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Hospital Santa Paula, São Paulo, SP, Brasil
| | - Cássia Gomes da Silveira Santos
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Universidade Federal do Paraná, Hospital das Clínicas, Curitiba, PR, Brasil
| | - Carmen Tzanno-Martins
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Clínica de Hemodiálise, São Paulo, SP, Brasil
| | - José Barros Neto
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Sociedade Brasileira de Nefrologia Mineira, Belo Horizonte, MG, Brasil.,Felício Rocho Hospital, Departamento de Nefrologia, Belo Horizonte, MG, Brasil
| | | | - Leda Lotaif
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Instituto Dante Pazzanese de Cardiologia, Nefrologia e Hipertensão e Pós-Graduação, São Paulo, SP, Brasil.,HCor, São Paulo, SP, Brasil
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19
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Lai CF, Cheng CI, Chang CH, Chen YT, Hwang HC, Lin SL, Huang JW, Huang SJ. Integrating the Surprise Question, Palliative Care Screening Tool, and Clinical Risk Models to Identify Peritoneal Dialysis Patients With High One-Year Mortality. J Pain Symptom Manage 2020; 60:613-621.e6. [PMID: 32278098 DOI: 10.1016/j.jpainsymman.2020.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
CONTEXT Universal screening to identify vulnerable patients who may receive limited benefits from life-sustaining treatments can facilitate palliative care in dialysis populations. OBJECTIVES We aimed to develop prediction models for one-year mortality in peritoneal dialysis (PD) patients. METHODS This prospective cohort study included 401 adult Taiwanese prevalent PD patients (average age 56.2 ± 14 years). In addition to obtaining clinical characteristics and laboratory data, the primary care nurses evaluated the surprise question (SQ) and palliative care screening tool (PCST) for each patient in March 2015. Multivariate logistic regression models were conducted to predict the primary outcome of one-year all-cause mortality. RESULTS There were 34 (8.5%) patients who died during the first year of follow-up. Patients allocated to the not surprised group according to the SQ and those who received a score of ≥4 on the PCST had increased odds of death (odds ratio 24.68 [95% CI 10.66-57.13] and 12.18 [95% CI 5.66-26.21], respectively). We also developed a clinical risk model for one-year mortality that included sex, dialysis vintage, coronary artery disease, malignancy, normalized protein nitrogen appearance, white blood cell count, and serum albumin and sodium levels. Integrating the SQ, PCST, and clinical risk model exhibited good discrimination with an area under the receiver operating characteristic curve of 0.95. Kaplan-Meier analysis showed worse survival in high-risk patients predicted by the integrated model (log-rank P < 0.001). CONCLUSION Screening with the use of the integrated measurement can identify high-risk PD patients. This approach may facilitate palliative care interventions for at-risk subpopulations.
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Affiliation(s)
- Chun-Fu Lai
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-I Cheng
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiau-Chien Hwang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuei-Liong Lin
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Wen Huang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Sheng-Jean Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Taipei City Hospital, Taipei, Taiwan
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20
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Dawson J, Brennan FP, Hoffman A, Josland E, Li KC, Smyth A, Brown MA. Prevalence of Taste Changes and Association with Other Nutrition-Related Symptoms in End-Stage Kidney Disease Patients. J Ren Nutr 2020; 31:80-84. [PMID: 32737017 DOI: 10.1053/j.jrn.2020.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Gastrointestinal symptoms are common in end-stage kidney disease (ESKD) and have been associated with reduced health-related quality of life and malnutrition. The aim of this study is to describe the prevalence of taste changes in an ESKD population and to evaluate whether taste changes are associated with the presence or severity of other nutrition-related symptoms and malnutrition. METHODS We conducted a retrospective audit of people with ESKD on conservative, nondialysis management or renal replacement therapy who had completed a taste change assessment. Taste change was assessed on a Likert scale from none to overwhelming. Descriptions of taste changes were also collected. Other outcomes included gastrointestinal symptoms collected using the iPOS-renal symptom inventory, nutritional status, and biochemical parameters. RESULTS In total, 298 patients were included in our analysis. Taste changes were reported in 38% of this cohort. Taste changes were significantly associated with upper gastrointestinal symptoms (nausea, vomiting, anorexia, and dry/sore mouth) and malnutrition. CONCLUSIONS Our findings indicate that taste changes are highly prevalent and probably under-recognized in ESKD. Further investigation of the association with malnutrition is needed. Future trials are needed to evaluate strategies to manage taste changes in this population.
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Affiliation(s)
- Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Kogarah, North South Wales, Australia.
| | - Frank P Brennan
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia
| | - Anna Hoffman
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia
| | - Elizabeth Josland
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia
| | - Kelly Chenlei Li
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia
| | - Alison Smyth
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia
| | - Mark A Brown
- Nephrology Department, St George Hospital, Kogarah, North South Wales, Australia; St George and Sutherland Clinical School, University of New South Wales, Kensington, North South Wales, Australia
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21
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Raj R, Thiruvengadam S, Ahuja KDK, Frandsen M, Jose M. Discussions during shared decision-making in older adults with advanced renal disease: a scoping review. BMJ Open 2019; 9:e031427. [PMID: 31767590 PMCID: PMC6887047 DOI: 10.1136/bmjopen-2019-031427] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults. DESIGN We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines. DATA SOURCES PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations). ELIGIBILITY CRITERIA FOR INCLUSION Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described. RESULTS 248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes. CONCLUSION When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.
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Affiliation(s)
- Rajesh Raj
- Department of Nephrology, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | | | - Mai Frandsen
- Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
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22
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Gutiérrez Sánchez D, Leiva-Santos JP, Macías López MJ, Cuesta-Vargas AI. Prevalence of symptoms in advanced chronic kidney disease. Nefrologia 2019; 38:560-562. [PMID: 30316480 DOI: 10.1016/j.nefro.2017.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/10/2017] [Accepted: 11/26/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Daniel Gutiérrez Sánchez
- Fundación Cudeca, Arroyo de la Miel, Málaga, España; Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | | | | | - Antonio I Cuesta-Vargas
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, Málaga, España.
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23
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Bravin AM, Trettene ADS, Andrade LGMD, Popim RC. Benefits of spirituality and/or religiosity in patients with Chronic Kidney Disease: an integrative review. Rev Bras Enferm 2019; 72:541-551. [DOI: 10.1590/0034-7167-2018-0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/18/2018] [Indexed: 01/25/2023] Open
Abstract
ABSTRACT Objective: Identify and analyze existing evidence regarding the benefits of spirituality and / or religiosity in patients with Chronic Kidney Disease. Method: Integrative review carried out through consultation of databases: Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, US National Library of Medicine and Scopus. The following descriptors were used: chronic kidney disease, spirituality and religion. Primary articles published by December 2017 were included. Results: Twenty-six articles were selected, from which four thematic categories emerged: benefits as a modality of coping, perception of quality of life, mental health and improvement of renal function after transplantation. Conclusion: Benefits included those related to situational coping modalities, such as the strengthening of hope, social support and coping with pain; those related to mental health, such as the lower risk of suicide and fewer depressive symptoms; improvement in the perception of quality of life and in renal function after transplantation.
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24
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O'Halloran P, Noble H, Norwood K, Maxwell P, Shields J, Fogarty D, Murtagh F, Morton R, Brazil K. Advance Care Planning With Patients Who Have End-Stage Kidney Disease: A Systematic Realist Review. J Pain Symptom Manage 2018; 56:795-807.e18. [PMID: 30025939 PMCID: PMC6203056 DOI: 10.1016/j.jpainsymman.2018.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/02/2023]
Abstract
CONTEXT Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation. OBJECTIVES The objectives of this study are 1) to identify implementation theories; 2) to identify factors that help or hinder implementation; and 3) to develop theory on how the intervention may work. METHODS We carried out a systematic realist review, searching seven electronic databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, and ScienceDirect. RESULTS Sixty-two papers were included in the review. CONCLUSION We identified two intervention stages-1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.
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Affiliation(s)
- Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom.
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
| | - Kelly Norwood
- School of Psychology, Ulster University, Coleraine Campus, Coleraine, United Kingdom
| | - Peter Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Health Sciences Building, Belfast, United Kingdom; Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Damian Fogarty
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Rachael Morton
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
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25
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Ivory SE, Polkinghorne KR, Khandakar Y, Kasza J, Zoungas S, Steenkamp R, Roderick P, Wolfe R. Predicting 6-month mortality risk of patients commencing dialysis treatment for end-stage kidney disease. Nephrol Dial Transplant 2018; 32:1558-1565. [PMID: 28073820 DOI: 10.1093/ndt/gfw383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is evidence that end-stage kidney disease patients who are older or with more comorbidity may have a poor trade-off between benefits of dialysis and potential harms. We aimed to develop a tool for predicting patient mortality in the early stages of receiving dialysis. Methods In 23 658 patients aged 15+ years commencing dialysis between 2000 and 2009 in Australia and New Zealand a point score tool was developed to predict 6-month mortality based on a logistic regression analysis of factors available at dialysis initiation. Temporal validation used 2009-11 data from Australia and New Zealand. External validation used the UK Renal Registry. Results Within 6 months of commencing dialysis 6.1% of patients had died. A small group (4.7%) of patients had a high predicted mortality risk (>20%), as predicted by the point score tool. Predictive variables were: older age, underweight, chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease (particularly for patients <60 years of age), late referral to nephrologist care and underlying cause of renal disease. The new point score tool outperformed existing models, and had an area under the receiver operating characteristic curve of 0.755 on temporal validation with acceptable calibration and 0.713 on external validation with poor calibration. Conclusion Our point score tool for predicting 6-month mortality in patients at dialysis commencement has sufficient prognostic accuracy to use in Australia and New Zealand for prognosis and identification of high risk patients who may be given appropriate supportive care. Use in other countries requires further study.
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Affiliation(s)
- Sara E Ivory
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
| | - Yeasmin Khandakar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, Victoria, Australia
| | | | - Paul Roderick
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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26
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Hazlewood GS, Bombardier C, Tomlinson G, Marshall D. A Bayesian model that jointly considers comparative effectiveness research and patients’ preferences may help inform GRADE recommendations: an application to rheumatoid arthritis treatment recommendations. J Clin Epidemiol 2018; 93:56-65. [DOI: 10.1016/j.jclinepi.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022]
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27
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Gutiérrez Sánchez D, Leiva-Santos JP, Cuesta-Vargas AI. Symptom Burden Clustering in Chronic Kidney Disease Stage 5. Clin Nurs Res 2017; 28:583-601. [PMID: 29115157 DOI: 10.1177/1054773817740671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with chronic kidney disease (CKD) Stage 5, experience multiple symptoms that negatively affect the health-related quality of life (HRQoL). This study examined the cluster of symptoms and their association with disease severity and comorbidities. The study sample included 123 patients with CKD Stage 5; 60 patients were in the dialysis group and 63 patients in the Conservative Kidney Management group. Symptom data were collected using the Spanish modified version of Palliative Care Outcome Scale-Symptoms (POS-S) Renal, a validated questionnaire to assess symptoms in this population. More than half of the patients described weakness, difficulty sleeping, and feeling depressed. Two symptom clusters were identified. There was no significant statistical correlation between disease severity and symptoms and between comorbidities and symptoms. The tendency of these symptoms to occur together has implications for improving symptom management in this population. Routine symptom assessment can be useful in clinical and research settings.
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Affiliation(s)
| | | | - Antonio I Cuesta-Vargas
- 3 University of Málaga, Málaga, Spain.,4 Queensland University of Technology, Brisbane, Australia
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28
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Stevenson J, Meade A, Randall AM, Manley K, Notaras S, Heaney S, Chan M, Smyth A, Josland E, Brennan FP, Brown MA. Nutrition in Renal Supportive Care: Patient-driven and flexible. Nephrology (Carlton) 2017. [DOI: 10.1111/nep.13090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jessica Stevenson
- St George Hospital; Kogarah Australia
- The University of Sydney; Sydney New South Wales Australia
| | | | | | | | | | - Susan Heaney
- John Hunter Hospital; New Lambton Heights Australia
- The University of Newcastle; Callaghan NSW Australia
| | | | | | | | | | - Mark A Brown
- St George Hospital; Kogarah Australia
- University of New South Wales; Sydney New South Wales Australia
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29
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Brady B, Redahan L, Donohoe CL, Mellotte GJ, Wall C, Higgins S. Renal patients at end of life: A 5-year retrospective review. PROGRESS IN PALLIATIVE CARE 2017. [DOI: 10.1080/09699260.2017.1363451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bernadette Brady
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, Dublin, Ireland
- Department of Palliative Medicine, Tallaght Hospital, Dublin, Ireland
| | - Lynn Redahan
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
| | | | - George J. Mellotte
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
- Department of Renal Medicine, St. James’s Hospital, Dublin, Ireland
| | - Catherine Wall
- Department of Renal Medicine, Tallaght Hospital, Dublin, Ireland
| | - Stephen Higgins
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, Dublin, Ireland
- Department of Palliative Medicine, Tallaght Hospital, Dublin, Ireland
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30
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Brennan F, Stewart C, Burgess H, Davison SN, Moss AH, Murtagh FE, Germain M, Tranter S, Brown M. Time to Improve Informed Consent for Dialysis: An International Perspective. Clin J Am Soc Nephrol 2017; 12:1001-1009. [PMID: 28377472 PMCID: PMC5460710 DOI: 10.2215/cjn.09740916] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The literature reveals that current nephrology practice in obtaining informed consent for dialysis falls short of ethical and legal requirements. Meeting these requirements represents a significant challenge, especially because the benefits and risks of dialysis have shifted significantly with the growing number of older, comorbid patients. The importance of informed consent for dialysis is heightened by several concerns, including: (1) the proportion of predialysis patients and patients on dialysis who lack capacity in decision making and (2) whether older, comorbid, and frail patients understand their poor prognosis and the full implications to their independence and functional status of being on dialysis. This article outlines the ethical and legal requirements for a valid informed consent to dialysis: (1) the patient was competent, (2) the consent was made voluntarily, and (3) the patient was given sufficient information in an understandable manner to make the decision. It then considers the application of these requirements to practice across different countries. In the process of informed consent, the law requires a discussion by the physician of the material risks associated with dialysis and alternative options. We argue that, legally and ethically, this discussion should include both the anticipated trajectory of the illness and the effect on the life of the patient with particular regard to the outcomes most important to the individual. In addition, a discussion should occur about the option of a conservative, nondialysis pathway. These requirements ensure that the ethical principle of respect for patient autonomy is honored in the context of dialysis. Nephrologists need to be open to, comfortable with, and skillful in communicating this information. From these clear, open, ethically, and legally valid consent discussions, a significant dividend will hopefully flow for patients, families, and nephrologists alike.
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Affiliation(s)
- Frank Brennan
- Departments of Nephrology and
- Palliative Care, St. George Hospital, Sydney, New South Wales, Australia
| | - Cameron Stewart
- Faculty of Law, University of Sydney, Sydney, New South Wales, Australia
| | | | - Sara N. Davison
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Alvin H. Moss
- Sections of Nephrology and
- Supportive Care, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Fliss E.M. Murtagh
- Department of Palliative Care, Cecily Saunders Institute, King’s College London, London, United Kingdom; and
| | - Michael Germain
- Division of Nephrology, Tufts University, Springfield, Massachusetts
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31
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Meade A, Stevenson J, Notaras S. Nutrition in renal supportive care: Is it time to bend the rules? Nephrology (Carlton) 2017; 22:341-342. [DOI: 10.1111/nep.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony Meade
- Royal Adelaide Hospital; Adelaide South Austalia Australia
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32
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Luckett T, Spencer L, Morton RL, Pollock CA, Lam L, Silvester W, Sellars M, Detering KM, Butow PN, Tong A, Clayton JM. Advance care planning in chronic kidney disease: A survey of current practice in Australia. Nephrology (Carlton) 2017; 22:139-149. [DOI: 10.1111/nep.12743] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales; New South Wales Australia
- Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
| | - Lucy Spencer
- Department of Renal Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Carol A Pollock
- Department of Renal Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Lawrence Lam
- Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
| | - William Silvester
- Respecting Patient Choices; Austin Health; Melbourne Victoria Australia
| | - Marcus Sellars
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Respecting Patient Choices; Austin Health; Melbourne Victoria Australia
| | - Karen M Detering
- Respecting Patient Choices; Austin Health; Melbourne Victoria Australia
| | - Phyllis N Butow
- School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Allison Tong
- School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Josephine M Clayton
- Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales; New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- HammondCare Palliative & Supportive Care Service; Greenwich Hospital; Sydney New South Wales
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Raj R, Ahuja KDK, Frandsen M, Jose M. Older patient considering treatment for advanced renal disease: protocol for a scoping review of the information available for shared decision-making. BMJ Open 2016; 6:e013755. [PMID: 27932341 PMCID: PMC5168622 DOI: 10.1136/bmjopen-2016-013755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Older adults constitute the largest group of patients on dialysis in most parts of the world. Management of advanced renal disease in the older adult is complex; treatment outcomes and prognosis can be markedly different from younger patients. Clinical teams caring for such patients are often called on to provide information regarding prognosis and outcomes with treatment-particularly, the comparison between having dialysis treatment versus not having dialysis. These discussions can be difficult for clinicians because they have to contend with incomplete or nascent data regarding prognosis and outcomes in this age group. We aim to summarise the currently available information regarding the prognosis and outcomes of advanced renal disease in the older adult by means of a scoping review of the literature. This article discusses our protocol. METHODS This scoping review will be undertaken in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A directed search will look for relevant articles in English (within electronic databases and the grey literature), written between 2000 and 2016, which have studied older patients with advanced renal disease (estimated glomerular filtration rate <30 mL/min/1.73 m2). After screening by two independent reviewers, selected articles will be analysed using a data charting tool. Reporting will include descriptions, analysis of themes using qualitative software and display of information using charts. ETHICS AND DISSEMINATION This scoping review will analyse previously collected data, and so does not require ethical approval. Results will be disseminated through academic journals, conferences and seminars. We anticipate that our summary of the currently available knowledge regarding the older adult with advanced renal disease will be a repository of information for clinicians in the field. We expect to identify areas of study that are suited to systematic reviews. Our findings can also be expected to influence guidelines and clinical practice recommendations in the future.
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Affiliation(s)
- Rajesh Raj
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Kiran D K Ahuja
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Mai Frandsen
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Gutiérrez-Sánchez D, Leiva-Santos JP, Sánchez-Hernández R, Hernández-Marrero D, Cuesta-Vargas AI. Spanish modified version of the palliative care outcome scale-symptoms renal: cross-cultural adaptation and validation. BMC Nephrol 2016; 17:180. [PMID: 27863475 PMCID: PMC5116210 DOI: 10.1186/s12882-016-0402-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/15/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4-5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire. METHODS The English version of the POS-S Renal was culturally adapted and translated into Spanish using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was pilot-tested in 30 patients. A total of 200 patients with CKD stage 4-5 filled in a modified Spanish version of the POS-S Renal and the MSAS-SF. Statistical analysis to evaluate the psychometric properties of the questionnaire was carried out. RESULTS The content validity index (CVI) was 0.97, which indicated that the content of the instrument is an adequate reflection of the symptoms in advanced CKD (ACKD). The factor analysis indicated a two-factor solution explaining 35.05% of total variance. The confirmatory factor analysis (CFA) demonstrated that the two factor model was well supported (comparative fit index = 0.98, root mean square error of approximation = 0.068). This assessment tool demonstrated a satisfactory test-retest reliability (r = 0.909 to factor 1, r = 0.695 to factor 2, r = 0.887 to total score), good internal consistency to factor 1 (α = 0.78) and moderate internal consistency to factor 2 (α = 0.56). Concurrent criterion-related validity with MSAS-SF was also demonstrated, with r = 0.860, which indicated a high degree of correlation with a validated instrument that has been used in patients with ACKD. CONCLUSIONS The Spanish modified version of the POS-S Renal is a reliable and valid instrument that can be used to assess symptoms in Spanish patients with CKD stage 4-5.
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Affiliation(s)
| | - Juan P. Leiva-Santos
- Cuidados Paliativos. Hospital de Manacor, Carretera de Manacor-Alcudia, Mallorca, Islas Baleares, Spain
| | - Rosa Sánchez-Hernández
- Departamento de Nefrología, Hospital General de Villalba, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Collado Villalba, Madrid, Spain
| | - Domingo Hernández-Marrero
- Departamento de Nefrología, Hospital Regional Universitario de Málaga, Av Carlos Haya s/n, 29010 Málaga, Spain
- Instituto de Investigación Biomédico de Málaga (IBIMA), Málaga, Spain
| | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 IBIMA, Málaga, Spain
- School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Queensland, Australia
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Morton RL, Kurella Tamura M, Coast J, Davison SN. Supportive Care: Economic Considerations in Advanced Kidney Disease. Clin J Am Soc Nephrol 2016; 11:1915-1920. [PMID: 27510455 PMCID: PMC5053800 DOI: 10.2215/cjn.12651115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Kidney supportive care describes multiple interventions for patients with advanced CKD that focus on improving the quality of life and addressing what matters most to patients. This includes shared decision making and aligning treatment plans with patient goals through advance care planning and providing relief from pain and other distressing symptoms. Kidney supportive care is an essential component of quality care throughout the illness trajectory. However, in the context of limited health care resources, evidence of its cost-effectiveness is required to support decisions regarding appropriate resource allocation. We review the literature and outline the evidence gaps and particular issues associated with measuring the costs, benefits, and cost-effectiveness of kidney supportive care. We find evidence that the dominant evaluative framework of a cost per quality-adjusted life year may not be suitable for evaluations in this context and that relevant outcomes may include broader measures of patient wellbeing, having care aligned with treatment preferences, and family satisfaction with the end of life care experience. To improve the evidence base for the cost-effectiveness of kidney supportive care, large prospective cohort studies are recommended to collect data on both resource use and health outcomes and should include patients who receive conservative kidney management without dialysis. Linkage to administrative datasets, such as Medicare, Hospital Episode Statistics, and the Pharmaceutical Benefits Scheme for prescribed medicines, can provide a detailed estimate of publicly funded resource use and reduce the burden of data collection for patients and families. Longitudinal collection of quality of life and functional status should be added to existing cohort or kidney registry studies. Interventions that improve health outcomes for people with advanced CKD, such as kidney supportive care, not only have the potential to improve quality of life, but also may reduce the high costs associated with unwanted hospitalization and intensive medical treatments.
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Affiliation(s)
- Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto and Stanford University School of Medicine, Stanford, California
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; and
| | - Sara N. Davison
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Brown MA. Planning Dialysis Care: You Might Be "Surprised". Am J Kidney Dis 2016; 68:8-10. [PMID: 27343808 DOI: 10.1053/j.ajkd.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Mark A Brown
- St George Hospital & University of NSW, Sydney, Australia.
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Chao CT, Tsai HB, Shih CY, Hsu SH, Hung YC, Lai CF, Ueng RH, Chan DC, Hwang JJ, Huang SJ. Establishment of a renal supportive care program: Experience from a rural community hospital in Taiwan. J Formos Med Assoc 2016; 115:490-500. [PMID: 26825873 DOI: 10.1016/j.jfma.2015.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/11/2015] [Accepted: 12/10/2015] [Indexed: 12/14/2022] Open
Abstract
Renal supportive care (RSC) denotes a care program dedicated for patients with acute, chronic renal failure, and end-stage renal disease (ESRD), aiming to offer maximal symptom relief and optimize patients' quality of life. The uncertainty of prognosis for patients with chronic kidney disease and ESRD, the sociocultural issues inherent to the Taiwanese society, and the void of structured and practical RSC pathway, contributes to the underrecognition and poor utilization of RSC. Taiwanese patients rarely receive information regarding RSC as part of a standardized care and are not commonly offered this option. In National Taiwan University Hospital Jinshan branch, we started a RSC subprogram, supported by the community-based palliative/hospice care main program. We focused on understanding the need and providing the choice of RSC to suitable candidates. A three-step and four-phase protocol was designed and implemented to identify appropriate patients and to enhance the applicability of the RSC. We harnessed family visit and home-based family meeting as a vehicle to understand the patients' preferences, to discover what ESRD patients and their family value most, and to introduce the option of RSC. In the current review, we described our pilot experience of establishing a RSC program in Taiwan, and discuss its potential advantage.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Bin Tsai
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yuan Shih
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Su-Hsuan Hsu
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Yu-Chien Hung
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Chun-Fu Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey-Hsiuang Ueng
- Department of Nursing, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu County, Taiwan
| | - Juey-Jen Hwang
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Egan R, Wood S, MacLeod R, Walker R. Spirituality in Renal Supportive Care: A Thematic Review. Healthcare (Basel) 2015; 3:1174-93. [PMID: 27417819 PMCID: PMC4934638 DOI: 10.3390/healthcare3041174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people's psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated.
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Affiliation(s)
- Richard Egan
- Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Sarah Wood
- Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Rod MacLeod
- Hammond Care and Northern Clinical School, University of Sydney, Sydney 2065, Australia.
| | - Robert Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
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Egan R, Macleod R, Tiatia R, Wood S, Mountier J, Walker R. Spiritual care and kidney disease in NZ: a qualitative study with New Zealand renal specialists. Nephrology (Carlton) 2015; 19:708-13. [PMID: 25196561 DOI: 10.1111/nep.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2014] [Indexed: 11/29/2022]
Abstract
AIM People with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Research suggests that attending to renal patients' spiritual needs may contribute to an improvement in their quality of life. The aim of this qualitative study was to investigate the provision of spiritual care in New Zealand renal units from the perspective of specialists. METHODS The study followed a generic qualitative approach and included semi-structured interviews with specialists recruited from New Zealand's ten renal centres. RESULTS Five specialist doctors and nine specialist nurses were recruited for interviews. Understandings of spirituality were broad, with most participants having an inclusive understanding. Patients' spiritual needs were generally acknowledged and respected though formal spiritual assessments were not done. Consideration of death was discussed as an often-unexamined need. The dominant position was that the specialists did not provide explicit spiritual care of patients but there was some ad hoc provision offered through pre-dialysis educators, family meetings, Māori liaison staff members and the efforts of individuals. Chaplains were well used in some services. Participants had received no pre and little in-service training or education in spiritual care. Suggestions for improvements included in-service training, better utilization of chaplaincy services and training in advance care planning. CONCLUSION Most participants indicated they would attempt to provide some form of spiritual care, either directly or by referring the patient to appropriate services. However, participants generally demonstrated a lack of confidence in addressing a patient's spiritual needs.
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Affiliation(s)
- Richard Egan
- Preventive and Social Medicine Department, University of Otago, Dunedin, New Zealand
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Wang WY, Tarng DC, Chiang LC, Chu CM, Wang KY. Evaluation of uraemic pruritus in long-term dialysis patients using a modified Chinese scale. Nephrology (Carlton) 2015; 20:632-8. [PMID: 25917940 DOI: 10.1111/nep.12495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 01/06/2023]
Abstract
AIM To examine the reliability and validity of a modified Chinese version of the uraemic pruritus scale for measurement of different degrees of itching, as well as to identify the predictors for the severity of uraemic pruritus among long-term dialysis patients. METHODS Long-term dialysis patients (n = 110) were recruited for a cross-sectional study from a medical centre in Taiwan. A modified Chinese version of the uraemic pruritus scale was used to evaluate sleep disturbance and the severity, frequency and distribution of itching. Reliability was evaluated using item-total correlations, Cronbach's α, and intra-class correlation. Validity was evaluated by the content validity index, predictive and discriminative validity. Multiple linear regression was used on the predictors for the severity of uraemic pruritus. RESULTS After optimization for reliability, the scale retained seven items. The Cronbach's α was 0.86, and the results showed that the scale had predictive and discriminative validity. High intact-parathyroid hormone and creatinine clearance rate were important predictors for the severity of uraemic pruritus. The severity of uraemic pruritus was the important predictor for the sleeping disturbance. CONCLUSION The modified uraemic pruritus scale can discriminate between patients with a total pruritus score of ≥11 and those with a score of 0 points. The modified Chinese scale is a useful tool for clinically assessing the various degrees of itching among long-term dialysis patients. Our study validates that it could apply to clinical practice in assessment of uraemic pruritus.
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Affiliation(s)
- Wei-Yun Wang
- Graduate Institute of Medical Sciences, National Defense Medical Centre, Taipei, Taiwan.,Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei, Taiwan.,Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
| | - Li-Chi Chiang
- School of Nursing, National Defense Medical Centre, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan
| | - Kwua-Yun Wang
- Graduate Institute of Medical Sciences, National Defense Medical Centre, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
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Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP. CKD in elderly patients managed without dialysis: survival, symptoms, and quality of life. Clin J Am Soc Nephrol 2015; 10:260-8. [PMID: 25614492 PMCID: PMC4317735 DOI: 10.2215/cjn.03330414] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/30/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Survival, symptom burden, and quality of life (QOL) are uncertain for elderly patients with advanced CKD managed without dialysis. We examined these outcomes in patients managed with renal supportive care without dialysis (RSC-NFD) and those planned for or commencing dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this prospective observational study, symptoms were measured using the Memorial Symptom Assessment Scale and the Palliative care Outcomes Scale - Symptoms (renal) inventory and QOL was measured using the Short Form-36 survey. This study comprised 273 predialysis patients who had usual nephrology care and 122 nondialysis pathway patients who also attended a renal supportive care clinic adding the skills of a palliative medicine team. A further 72 patients commenced dialysis during this period without attending either clinic. RESULTS Nondialysis patients were older than the predialysis group (82 versus 67 years; P<0.001) but had similar eGFR at the first clinic visit (16 ml/min per 1.73 m(2); P=0.92). Of the predialysis patients, 92 (34%) commenced dialysis. Compared with the RSC-NFD group, the death rate was lower in the predialysis group who did not require dialysis (hazard ratio, 0.23; 95% confidence interval, 0.12 to 0.41] and in those requiring dialysis (0.30; 0.13 to 0.67) but not in dialysis patients who had not attended the predialysis clinic (0.60; 0.35 to 1.03). Median survival in RSC-NFD patients was 16 (interquartile range, 9, 37) months and 32% survived >12 months after eGFR fell below 10 ml/min per 1.73 m(2). For the whole group, age, serum albumin, and eGFR <15 ml/min per 1.73 m(2) were associated with poorer survival. Of the nondialysis patients, 57% had stable or improved symptoms over 12 months and 58% had stable or improved QOL. CONCLUSIONS Elderly patients who choose not to have dialysis as part of shared decision making survive a median of 16 months and about one-third survive 12 months past a time when dialysis might have otherwise been indicated. Utilizing the skills of palliative medicine helps provide reasonable symptom control and QOL without dialysis.
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Affiliation(s)
- Mark A Brown
- Department of Renal Medicine, St. George Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia; and
| | - Gemma K Collett
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
| | | | - Celine Foote
- George Institute for Global Health, Sydney, Australia
| | - Qiang Li
- George Institute for Global Health, Sydney, Australia
| | - Frank P Brennan
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
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Brennan F, Collett G, Josland EA, Brown MA. The symptoms of patients with CKD stage 5 managed without dialysis. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Schoonover KL, Hickson LJ, Norby SM, Hogan MC, Chaudhary S, Albright RC, Dillon JJ, McCarthy JT, Williams AW. Risk factors for hospitalization among older, incident haemodialysis patients. Nephrology (Carlton) 2014; 18:712-7. [PMID: 23848358 DOI: 10.1111/nep.12129] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 01/10/2023]
Abstract
AIMS The number of elderly persons with end-stage renal disease is increasing with many requiring hospitalizations. This study examines the causes and predictors of hospitalization in older haemodialysis patients. METHODS We reviewed hospitalizations of older (≥65 years) incident chronic haemodialysis patients initiating therapy between 1 January 2007 and 31 December 2009 under the care of a single Midwestern United States dialysis provider. RESULTS Of 125 patients, the mean age was 76 ± 7 years and 72% were male. At first dialysis, 68% used a central venous catheter (CVC) and 51% were in the hospital. Mean follow-up was 1.8 ± 1.0 years. At least one hospitalization occurred in 89 (71%) patients and half of all patients were hospitalized once within the first 223 days. Total hospital admission rate was 1.48 per patient year with hospital days totalling 8.54 days per patient year. The three most common reasons for first admission were cardiac (33%), infection (18%) and gastrointestinal (12%). Predictors of future hospitalization included the first dialysis occurring in hospital (hazard ratios (HR) 2.1, 95% CI 1.4-3.3, P = 0.0005) and the use of a CVC at first haemodialysis (HR 2.6, CI 1.6-4.4, P < 0.0001). CONCLUSION Hospitalizations are common in older incident haemodialysis patients. Access preparation and overall burden of illness leading to the initial hospitalization appear to play a role. Identification of additional factors associated with hospitalization will allow for focused interventions to reduce hospitalization rates and increase the value of care.
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Affiliation(s)
- Kimberly L Schoonover
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Luckett T, Sellars M, Tieman J, Pollock CA, Silvester W, Butow PN, Detering KM, Brennan F, Clayton JM. Advance Care Planning for Adults With CKD: A Systematic Integrative Review. Am J Kidney Dis 2014; 63:761-70. [DOI: 10.1053/j.ajkd.2013.12.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 12/17/2013] [Indexed: 01/24/2023]
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