Palliative care in nephrology
Authors:
Barbora Szonowská
Authors‘ workplace:
Interní oddělení Strahov, Všeobecná fakultní nemocnice v Praze
Published in:
Čas. Lék. čes. 2018; 157: 25-29
Category:
Review Article
Navzdory pokroku v dialyzační technologii v průběhu posledních desetiletí mají pacienti s pokročilým chronickým onemocněním ledvin (CKD) stále vysokou zátěž symptomy, zkrácené přežívání a jsou vystaveni značnému fyzickému, emočnímu a spirituálnímu utrpení. Přibývá nemocných s pokročilým onemocněním ledvin, pro které je zahájení nebo pokračování v dialyzační léčbě spojeno s vysokým rizikem časného úmrtí nebo zhoršením funkčního stavu.
Overview
Despite the advances in dialysis technology over the past decades, patients with advanced chronic kidney disease (CKD) have a high symptom burden, shortened survival and substantial physical, emotional and spiritual suffering. Number of frailty patients with advanced chronic kidney disease is growing and for many of them the beginning or continuation of dialysis is associated with a high risk of short-term mortality or worsening of functional status.
Identifying these fragile patients and integrating palliative care into standard nephrological care improves patients’ quality of life and has the potential to prolong their lives without demanding dialysis treatment. Nephrologists’ basic skills should include: estimating the prognosis, communication with the patient on advance care planning including end-of-life issues and consistent symptom management. In fragile patients with advanced chronic kidney disease, the disease-oriented model with quantitative targets is no longer an adequate approach to care.
Keywords:
palliative/supportive care, chronic kidney disease, advance care planning, shared-decision making, conservative management, palliative dialysis, withdrawal from dialysis.
Sources
1. Kurella Tamura M, Tan JC, O’Hara AM. Optimizing renal replacement therapy in older adults: a framework for making individualized decisions. Kidney Int 2012; 82: 261–269.
2. Davison SN, Moss AH. Supportive Care: Meeting the Needs of Patients with Advanced Chronic Kidney Disease. Clin J Am Soc Nephrol 2016; 11: 1879–1880.
3. Murtagh FEM, Burns A, Moranne O et al. Supportive care: comprehensive conservative care in end-stage-kidney disease. Clin J Am Soc Nephrol 2016; 11: 1909–1914.
4. Rosansky SJ, Clark WF. Has the yearly increase in the renal replacement therapy population ended? J Am Soc Nephrol 2013; 24: 1367–1370.
5. Grace B, Hurst K, McDonald S. ANZDATA. 35th Annual Report. Australia and New Zealand Dialysis and Transplant Registry, 2012.
6. U. S. Renal Data System. Incidence, prevalence, patient characteristics and treatment modalities. In: USRDS 2014 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2014.
7. Ansell D, Castledine C, Freehally J et al. UK Renal Registry 12th annual report. The Renal Association, 2009.
8. Rychlík I, Lopot F. Statistická ročenka dialyzační léčby v ČR za rok 2016. Česká nefrologická společnost, 2017. Dostupné na: www.nefrol.cz/odbornici/dialyzacni-statistika
9. Brown EA. Peritoneal dialysis for older people: overcoming the barriers. Kidney Int 2008; 73: 68–71.
10. Kurella Tamura M, Covinsky KE, Chertow GM et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009; 361: 1539–1547.
11. Carson R , Juszczak M, Davenport A et al. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 2009; 4: 1611–1619.
12. Hedayati SS, Minhajuddin AT, Toto RD et al. Prevalence of major depressive episode in CKD. Am J Kidney Dis 2009; 54: 424–432.
13. U. S. Renal Data System. Incidence, prevalence, patient characteristics and treatment modalities. In: USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2011.
14. Singh P, Germain MJ, Cohen L et al. The elderly patient on dialysis: geriatric considerations. Nephrol Dial Transplant 2014; 29: 990–996.
15. Murtagh FE, Marsh JE, Donohoe P et al. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 2007; 22: 1955–1962.
16. Brown MA, Collett GK, Josland EA et al. CKD in elderly patients managed without dialysis: survival, symptoms, and quality of life. Clin J Am Soc Nephrol 2015; 10(2): 169–171.
17. Davison SN, Levin A, Moss AH et al.; Kidney Disease: Improving Global Outcomes. Executive summary of the KDIGO Controversies Conference on Supportive Care in CKD: developing a roadmap to improving quality care. Kidney Int 2015; 88: 447–459.
18. Farrington K, Covic A, Aucella F et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher. Nephrol Dial Transplant 2016; 31(Suppl. 2): ii1–ii66.
19. Vandecasteele S J, Kurella Tamura M. A patient-centered vision of care for ESRD: dialysis as a bridging treatment or as a final destination? J Am Soc Nephrol 2014; 25 (8): 1647–1651.
20. Couchoud C, Hemmelgarn B, Kotanko P et al. Supportive care: time to change our prognostic tools and their use in CKD. Clin J Am Soc Nephrol 2016; 11: 1892–1901.
21. Couchoud C, Labeeuw M, Moranne O et al.; French Renal Epidemiology and Information Network (REIN) registry: A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant 2009; 24: 1553–1561.
22. Couchoud C, Beuscart JB, Aldigier JC et al.; REIN registry. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 2015; 88: 1178–1186.
23. Cohen LM, Ruthazer R, Moss AH et al. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol 2010; 5: 72–79.
24. Moss AH. Shared decision-making in dialysis: the new RPA/ASN guideline on appropriate initiation and withdrawal of treatment. Am J Kidney Dis 2001; 37: 1081–1091.
25. Holley JL. Palliative care in end-stage renal disease: illness trajectories, communication and hospice use. Adv Chronic Kidney Dis 2007; 14(4): 402–408.
26. Brown E, Murtagh FEM, Murphy E. Communication with patients and families. In: Brown E, Murtagh F, Murphy E (eds.). Kidney Disease: From advanced disease to bereavement (2nd ed.). Oxford University Press, 2012: 199–224.
27. Brown E, Murtagh FEM, Murphy E. Symptom assessment and trajectories. In: Brown E, Murtagh FEM, Murphy E (eds.). Kidney Disease: From advanced disease to bereavement (2nd ed.). Oxford University Press, 2012: 91–102.
28. Quill TE, Abernethy AP. Generalist plus specialist palliative care – creating a more sustainable model. N Engl J Med 2013; 368: 1173–1175.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric nephrology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Nephrology Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
![Issue 1](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/1caefbb45d5d071a59edb296e5692b9e.jpeg)
Most read in this issue
- Palliative care for patients at home
- Palliative care in nephrology
- The review of questionnaires and scales evaluating patients with amyotrophic lateral sclerosis
- Geriatric palliative care