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Palliative CKD

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https://www.readbyqxmd.com/read/28638606/palliative-care-for-patients-with-end-stage-renal-disease-approach-to-treatment-that-aims-to-improve-quality-of-life-and-relieve-suffering-for-patients-and-families-with-chronic-illnesses
#1
Amy Rak, Rupesh Raina, Theodore T Suh, Vinod Krishnappa, Jessica Darusz, Charles W Sidoti, Mona Gupta
Providing end-of-life care to patients suffering from chronic kidney disease (CKD) and/or end-stage renal disease often presents ethical challenges to families and health care providers. However, as the conditions these patients present with are multifaceted in nature, so should be the approach when determining prognosis and treatment strategies for this patient population. Having an interdisciplinary palliative team in place to address any concerns that may arise during conversations related to end-of-life care encourages effective communication between the patient, the family and the medical team...
February 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28635159/nutrition-in-renal-supportive-care-patient-driven-and-flexible
#2
REVIEW
Jessica Stevenson, Anthony Meade, Ann-Maree Randall, Karen Manley, Stephanie Notaras, Susan Heaney, Maria Chan, Alison Smyth, Elizabeth Josland, Frank Brennan, Mark A Brown
Renal Supportive Care is an alternative treatment pathway in advanced Chronic Kidney Disease (CKD) that is being increasingly adopted, particularly in the elderly. RSC utilises principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non-dialysis pathway. Nutrition management is often an under-recognised component of care, and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of RSC are met...
June 20, 2017: Nephrology
https://www.readbyqxmd.com/read/28629462/treatment-decisions-for-older-adults-with-advanced-chronic-kidney-disease
#3
REVIEW
Steven J Rosansky, Jane Schell, Joseph Shega, Jennifer Scherer, Laurie Jacobs, Cecile Couchoud, Deidra Crews, Matthew McNabney
Dialysis initiation rates among older adults, aged 75 years or greater, are increasing at a faster rate than for younger age groups. Older adults with advanced CKD (eGFR < 30 ml/min/1.73 m(2)) typically lose renal function slowly, often suffer from significant comorbidity and thus may die from associated comorbidities before they require dialysis.A patient's pattern of renal function loss over time in relation to their underlying comorbidities can serve as a guide to the probability of a future dialysis requirement...
June 19, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28612998/symptom-experience-in-non-dialysis-dependent-chronic-kidney-disease-a-qualitative-descriptive-study
#4
Karen Pugh-Clarke, Sue Cheryl Read, Julius Sim
BACKGROUND: Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high-quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory...
June 14, 2017: Journal of Renal Care
https://www.readbyqxmd.com/read/28538218/dialysis-therapy-and-conservative-management-of-advanced-chronic-kidney-disease-in-the-elderly-a-systematic-review
#5
Supakanya Wongrakpanich, Paweena Susantitaphong, Suramath Isaranuwatchai, Jirat Chenbhanich, Somchai Eiam-Ong, Bertrand L Jaber
BACKGROUND: Dialysis in older adults with chronic kidney disease (CKD) and comorbidities may not be associated with improved life expectancy compared to conservative management. To inform clinical practice, we performed a systematic review of all available studies examining this hypothesis. METHODS: We performed a systematic review of retrospective and prospective cohort studies of older adults with stage-5 CKD who chose dialysis (hemodialysis or peritoneal dialysis) or opted for conservative management (including management of complications of CKD and palliative care)...
May 25, 2017: Nephron
https://www.readbyqxmd.com/read/28535522/restenosis-in-hemodialytic-fistulas-and-chronic-kidney-disease-associated-vascular-disease-two-pathologies-driven-by-metakaryotic-stem-cells
#6
Gianandrea Pasquinelli, William G Thilly, Elena V Gostjeva, Paola Todeschini, Giuseppe Cianciolo, Claudio Ronco, Gaetano La Manna
Chronic kidney disease (CKD) exacerbating vascular disease poses a major challenge to nephrology. Surgically placed vascular fistulas, as an aid to hemodialysis prior to kidney transplant, have extended many lives, while post-surgical restenosis closure of the fistula by smooth muscle cells affects many lives. When post-surgical restenosis is developed, palliative measures are almost always surgical: there are no effective drug treatments. In this study, we offer a testable hypothesis that effects of CKD on widely distributed vascular diseases and the phenomenon of fistula restenosis are both driven by the pathologic creation of non-dividing smooth muscle cells via asymmetric division of exponentially increasing metakaryotic stem cells...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28474361/iconnect-ckd-virtual-medical-consulting-a-web-based-chronic-kidney-disease-hypertension-and-diabetes-integrated-care-program
#7
Ivor J Katz, Saiyini Pirabhahar, Paula Williamson, Vishwas Raghunath, Frank Brennan, Anthony O'Sullivan, George Youssef, Cathie Lane, Gary Jacobson, Peter Feldman, John Kelly
AIMS: Chronic kidney disease (CKD) patients overwhelm specialist services and can potentially be managed in the primary care (PC). Opportunistic screening of high risk (HR) patients and follow-up in PC is the most sustainable model of care. A 'virtual consultation' (VC) model instead of traditional face to face (F2F) consultations was used, aiming to assess efficacy and safety of the model. METHODS: Seventy patients were recruited from PC sites and hospital clinics, and followed for one year...
May 4, 2017: Nephrology
https://www.readbyqxmd.com/read/28463635/research-priorities-for-palliative-care-for-older-adults-with-advanced-chronic-kidney-disease
#8
Ann M O'Hare, Mi-Kyung Song, Manjula Kurella Tamura, Alvin H Moss
Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population. In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the "best care possible" for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD...
May 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27881247/pain-management-in-ckd-a-guide-for-nephrology-providers
#9
REVIEW
Holly M Koncicki, Mark Unruh, Jane O Schell
Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis...
March 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27863475/spanish-modified-version-of-the-palliative-care-outcome-scale-symptoms-renal-cross-cultural-adaptation-and-validation
#10
Daniel Gutiérrez-Sánchez, Juan P Leiva-Santos, Rosa Sánchez-Hernández, Domingo Hernández-Marrero, Antonio I Cuesta-Vargas
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...
November 18, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27669324/symptom-management-in-patients-with-stage-5-ckd-opting-for-conservative-management
#11
REVIEW
Sheila Johnston
Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms...
September 22, 2016: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/27510454/supportive-care-integration-of-patient-centered-kidney-care-to-manage-symptoms-and-geriatric-syndromes
#12
Sara N Davison, Sarbjit Vanita Jassal
Dialysis care is often associated with poor outcomes including low quality of life (QOL). To improve patient-reported outcomes, incorporation of the patient's needs and perspective into the medical care they receive is essential. This article provides a framework to help clinicians integrate symptom assessment and other measures such as QOL and frailty scores into a clinical approach to the contemporary supportive care of patients with advanced CKD. This approach involves (1) defining our understanding of kidney supportive care, patient-centered dialysis, and palliative dialysis; (2) understanding and recognizing common symptoms associated with advanced CKD; (3) discussing the concepts of physical function, frailty, and QOL and their role in CKD; and (4) identifying the structural and process barriers that may arise when patient-centered dialysis is being introduced into clinical practice...
October 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27349639/acupuncture-and-related-interventions-for-symptoms-of-chronic-kidney-disease
#13
REVIEW
Kun Hyung Kim, Myeong Soo Lee, Tae-Hun Kim, Jung Won Kang, Tae-Young Choi, Jae Dong Lee
BACKGROUND: People living with chronic kidney disease (CKD) experience a range of symptoms and often have complex comorbidities. Many pharmacological interventions for people with CKD have known risks of adverse events. Acupuncture is widely used for symptom management in patients with chronic diseases and in other palliative care settings. However, the safety and efficacy of acupuncture for people with CKD remains largely unknown. OBJECTIVES: We aimed to evaluate the benefits and harms of acupuncture, electro-acupuncture, acupressure, moxibustion and other acupuncture-related interventions (alone or combined with other acupuncture-related interventions) for symptoms of CKD...
June 28, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27106111/assessment-of-kidney-function-in-survivors-following-fontan-palliation
#14
Sheena Sharma, Rebecca L Ruebner, Susan L Furth, Kathryn M Dodds, Jack Rychik, David J Goldberg
OBJECTIVE: The Fontan operation is a palliative procedure for congenital single ventricle heart disease. Long-term kidney function in this cohort is not well-known. Our aim was to evaluate renal function in long-term survivors post-Fontan palliation, and we hypothesize that this cohort will have a higher prevalence of chronic kidney disease (CKD) compared to controls. DESIGN: We performed a retrospective cohort study of 68 subjects evaluated through the Single Ventricle Survivorship Program at the Children's Hospital of Philadelphia between July 2010 and December 2014 compared to 70 healthy children similar in age and sex...
December 2016: Congenital Heart Disease
https://www.readbyqxmd.com/read/26882634/palliative-care-in-patients-with-advanced-chronic-kidney-disease
#15
Betty Ann Wasylynuk, Sara N Davison
The past five decades have shown a tremendous growth, world wide, in the number of patients with advanced chronic kidney disease (CKD). Patients with advanced CKD today are notably older, have significant comorbidity, substantial symptom burden and, ultimately, have high mortality. Subsequently, there is an increased global awareness of the need to integrate palliative care into routine kidney care to enhance the quality of life and death for patients with advanced CKD. This article outlines a conceptual framework for kidney palliative care for patients with advanced CKD and discusses issues such as symptom burden, illness trajectories, advance care planning, and complex decision-making, including decisions around the appropriate initiation, withholding and withdrawal of dialysis, and the potential palliative care roles and responsibilities for nursing staff within kidney care programs...
July 2015: CANNT Journal, Journal ACITN
https://www.readbyqxmd.com/read/26718957/use-of-erythropoietin-stimulating-agents-esa-in-patients-with-end-stage-renal-failure-decided-to-forego-dialysis-palliative-perspective
#16
Hon Wai Benjamin Cheng, Kwok Ying Chan, Hoi To Lau, Ching Wah Man, Suk Ching Cheng, Carman Lam
Normochromic normocytic anemia is a common complication in chronic kidney disease (CKD) and is associated with many adverse clinical consequences. Erythropoiesis-stimulating agents (ESAs) act to replace endogenous erythropoietin for patients with end-stage renal disease having anemia. Today, ESAs remain the main tool for treating anemia associated with CKD. In current practice, the use of ESA is not limited to the patients on renal replacement therapy but has extended to nondialysis patients under palliative care (PC)...
December 29, 2015: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/26709063/conservative-care-of-the-elderly-ckd-patient-a-practical-guide
#17
REVIEW
Divya Raghavan, Jean L Holley
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life...
January 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/26163382/palliative-care-in-chronic-kidney-disease-the-packs-study-quality-of-life-decision-making-costs-and-impact-on-carers-in-people-managed-without-dialysis
#18
MULTICENTER STUDY
Helen Rose Noble, Ashley Agus, Kevin Brazil, Aine Burns, Nicola A Goodfellow, Mary Guiney, Fiona McCourt, Cliona McDowell, Charles Normand, Paul Roderick, Colin Thompson, A P Maxwell, M M Yaqoob
BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK...
July 11, 2015: BMC Nephrology
https://www.readbyqxmd.com/read/25923985/executive-summary-of-the-kdigo-controversies-conference-on-supportive-care-in-chronic-kidney-disease-developing-a-roadmap-to-improving-quality-care
#19
Sara N Davison, Adeera Levin, Alvin H Moss, Vivekanand Jha, Edwina A Brown, Frank Brennan, Fliss E M Murtagh, Saraladevi Naicker, Michael J Germain, Donal J O'Donoghue, Rachael L Morton, Gregorio T Obrador
Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis...
September 2015: Kidney International
https://www.readbyqxmd.com/read/25807845/dialysis-withdrawal-impact-and-evaluation-of-a-multidisciplinary-deliberation-within-an-ethics-committee-as-a-shared-decision-making-model
#20
Jocelyne Maurizi Balzan, Jean Charles Cartier, Silvia Calvino-Gunther, Pierre Louis Carron, Patrice Baro, Pedro Palacin, Paul Vialtel
Since dialysis withdrawal in maintenance dialysis patients with limited life expectancy results always in short-term death, nephrologists need a referenced process to make their decision. This study reviews 8 years of operation of an Ethics Committee in Nephrology (ECN). The ECN, within a multidisciplinary team, once a month explores cases reported by caregivers when maintaining dialysis seems not to be in the patient's best interest. Discussion is required when the vital prognosis is engaged by the evolution of the chronic kidney disease (CKD) or the occurrence of an acute medical event...
August 2015: Therapeutic Apheresis and Dialysis
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