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Renal Conservative and Palliative Care

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273 papers 100 to 500 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Richard E Leiter, Miryam Yusufov, Mohammad Adrian Hasdianda, Lauren A Fellion, Audrey C Reust, Susan D Block, James A Tulsky, Kei Ouchi
CONTEXT: Emergency Department (ED) visits provide opportunities to empower patients to discuss advance care planning (ACP) with their outpatient clinicians, but systematically developed, feasible interventions do not currently exist. Brief negotiated interview (BNI) interventions, which allow ED clinicians to efficiently motivate patients, have potential to meet this need. OBJECTIVES: We developed a BNI ED intervention to empower older adults with life-limiting illness to formulate and communicate medical care goals to their primary outpatient clinicians...
September 14, 2018: Journal of Pain and Symptom Management
Cherie Kapell Brown, Jennifer Kryworuchko, Wanda Martin
BACKGROUND: People with end stage renal disease (ESRD) face important health-related decisions concerning end-of-life care and the use of life-support technologies. While people often want to be involved in making decisions about their health, there are many challenges. People with advanced illness may have limited or wavering ability to participate fully in decision-making conversations - or lack decisional capacity for making decisions. Additionally, they may have a limited understanding of CPR and tend to receive inconsistent information on the process and outcome of CPR...
September 12, 2018: BMC Nephrology
Kirsten L Johansen, Cynthia Delgado, George A Kaysen, Glenn M Chertow, Janet Chiang, Lorien S Dalrymple, Mark R Segal, Barbara A Grimes
Background: Understanding how components of frailty change over time and how they can be modeled as time-dependent predictors of mortality could lead to better risk prediction in the dialysis population. Methods: We measured frailty at baseline, 12, and 24 months among 727 patients receiving hemodialysis in Northern California and Atlanta. We examined the likelihood of meeting frailty components (weight loss, exhaustion, low physical activity, weak grip strength, and slow gait speed) as a function of time in logistic regression analysis and association of frailty components with mortality in time-updated multivariable Cox models...
September 5, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Anne M Kelemen, Hunter Groninger
No abstract text is available yet for this article.
September 4, 2018: JAMA Internal Medicine
Alze Pereira Dos Santos Tavares, Carmen Tzanno-Matins, Marcio J C Arruda, Bárbara Antunes
BACKGROUND: Renal Supportive/Palliative Care is gaining gradual recognition as a patient-centered care approach that should be integrated to the traditional disease-centered model of care, mainly in elder patients with advanced chronic kidney disease (CKD). The objective of this study was to assess knowledge, perceptions, attitude, experience and interest in palliative care among renal care providers. METHODS: Online survey, administered between May 23 to June 13, 2017 to members of the Brazilian Society of Nephrology (BSN)...
August 3, 2018: Annals of Palliative Medicine
Anita E Molzahn, Laurene Sheilds, Anne Bruce, Kara Schick-Makaroff, Marcy Antonio, Lacie White
AIMS: To describe how people diagnosed with chronic kidney disease and their family members describe uncertainty related to impending death. BACKGROUND: There has been little research regarding the experiences of people with chronic kidney disease and their family members as they near the end of life. We need to understand these experiences to provide holistic person-centered care. DESIGN: A narrative inquiry was undertaken using a social constructionist perspective...
August 21, 2018: Journal of Advanced Nursing
Wouter R Verberne, Janneke Dijkers, Johannes C Kelder, Anthonius B M Geers, Wilbert T Jellema, Hieronymus H Vincent, Johannes J M van Delden, Willem Jan W Bos
BACKGROUND: Conservative care is argued to be a reasonable treatment alternative for dialysis in older patients with advanced chronic kidney disease (CKD). However, comparisons are scarce and generally focus on survival only. Comparative data on more patient-relevant outcomes are needed to truly foster shared decision-making on an individual level, and cost comparison is needed to assess value of care. METHODS: We conducted a retrospective observational single-center cohort study in 366 patients aged ≥70 years with advanced CKD, who chose dialysis (n = 240) or conservative care (n = 126) after careful counselling by a multidisciplinary team in a non-academic teaching hospital in The Netherlands...
August 16, 2018: BMC Nephrology
Robert N Foley, Donal J Sexton, Paul Drawz, Areef Ishani, Scott Reule
BACKGROUND: End-of-life care is a prominent consideration in patients on maintenance dialysis, especially when death appears imminent and quality of life is poor. To date, examination of race- and ethnicity-associated disparities in end-of-life care for patients with ESRD has largely been restricted to comparisons of white and black patients. METHODS: We performed a retrospective national study using United States Renal Data System files to determine whether end-of-life care in United States patients on dialysis is subject to racial or ethnic disparity...
September 2018: Journal of the American Society of Nephrology: JASN
Agnes Katalin Urban, Celine Foote, Frank P Brennan, Mark Brown, Brendon Lee
AIM: To explore the quality of deaths in the acute hospital under a Nephrology service at two teaching hospitals in Sydney with Renal Supportive Care services over time. METHODS: Retrospective chart review of all deaths in the years 2004, 2009 and 2014 at St George Hospital (SGH) and in 2014 at Concord Repatriation General Hospital (CRGH). Domains assessed were recognition of dying, invasive interventions, symptom assessment, anticipatory prescribing, documentation of spiritual needs and bereavement information for families...
August 9, 2018: Nephrology
Amar D Bansal, Nina R O'Connor, David J Casarett
BACKGROUND: Dialysis is often initiated in the hospital during episodes of acute kidney injury and critical illness. Little is known about how patients or their surrogate decision makers feel about dialysis initiation in the inpatient setting. METHODS: We conducted a prospective cohort study at a large academic center in the United States. All patients who initiated dialysis during a 30-day period in 2016 were approached for enrollment. Study participants were defined as individuals who provided consent for dialysis initiation - either the patient or a surrogate decision-maker...
August 8, 2018: BMC Nephrology
Sara N Davison
Kidney supportive care requires a highly personalized approach to care. Precision medicine holds promise for a deeper understanding of the pathophysiology of symptoms and related syndromes and more precise individualization of prognosis and treatment estimates, therefore providing valuable opportunities for greater personalization of supportive care. However, the major drivers of quality of life are psychosocial, economic, lifestyle, and preference-based, and consideration of these factors and skilled communication are integral to the provision of excellent and personalized kidney supportive care...
July 2018: Seminars in Nephrology
Gihad E Nesrallah, Stephanie N Dixon, Marnie MacKinnon, Sarbjit Vanita Jassal, Sarah E Bota, Jade S Dirk, Erin Arthurs, Peter G Blake, Manish M Sood, Amit X Garg, Sara N Davison
Background: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives: We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario. Methods: We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets...
2018: Canadian Journal of Kidney Health and Disease
Kathryn Eckert, Lila Motemaden, Michelle Alves
Patients with end-stage renal disease (ESRD) should choose a treatment modality, such as hemodialysis (HD) or conservative medical management (CMM), to improve their symptoms with the goal of attaining a good quality of life (QOL), a concept highly aligned with palliative care principles. This article aims to answer if elderly patients with ESRD have improved QOL with CMM compared with HD. Conservative medical management focuses on managing symptoms, rather than invasive procedures such as HD, with more focus on holistic care...
June 2018: Journal of Hospice and Palliative Nursing: JHPN
Keren Ladin, Renuka Pandya, Ronald D Perrone, Klemens B Meyer, Allison Kannam, Rohini Loke, Tira Oskoui, Daniel E Weiner, John B Wong
BACKGROUND AND OBJECTIVES: Despite guidelines recommending shared decision making, nephrologists vary significantly in their approaches to discussing conservative management for kidney replacement therapy with older patients. Many older patients do not perceive dialysis initiation as a choice or receive sufficient information about conservative management for reasons incompletely understood. We examined how nephrologists' perceptions of key outcomes and successful versus failed treatment discussions shape their approach and characterized different models of decision making, patient engagement, and conservative management discussion...
August 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Manuel Carlos Martins Castro
Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metabolic alterations and symptoms associated to end-stage renal disease is an important element in providing patients with good palliative care...
July 23, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Joy Chieh-Yu Chen, Bjorg Thorsteinsdottir, Lisa E Vaughan, Molly A Feely, Robert C Albright, Macaulay Onuigbo, Suzanne M Norby, Christy L Gossett, Margaret M D'Uscio, Amy W Williams, John J Dillon, LaTonya J Hickson
BACKGROUND AND OBJECTIVES: Withdrawal from maintenance hemodialysis before death has become more common because of high disease and treatment burden. The study objective was to identify patient factors and examine the terminal course associated with hemodialysis withdrawal, and assess patterns of palliative care involvement before death among patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed an observational cohort study of adult patients on incident hemodialysis in a midwestern United States tertiary center, from January 2001 to November 2013, with death events through to November 2015...
August 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Alexis Chettiar, Maria Montez-Rath, Sai Liu, Yoshio N Hall, Ann M O'Hare, Manjula Kurella Tamura
BACKGROUND AND OBJECTIVES: Palliative care may improve quality of life and reduce the cost of care for patients with chronic illness, but utilization and cost implications of palliative care in ESKD have not been evaluated. We sought to determine the association of inpatient palliative care with health care utilization and postdischarge outcomes in ESKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In analyses stratified by whether patients died during the index hospitalization, we identified Medicare beneficiaries with ESKD who received inpatient palliative care, ascertained by provider specialty codes, between 2012 and 2013...
August 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Fayez Ebrahim Alshamsi, Ahmed Chaaban, Mona Alrukhaimi, Bassam Bernieh, Omran Bakoush
Patients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians' practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians' practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS)...
December 2018: Libyan Journal of Medicine
Robert M Taylor, Johnson Wu
No abstract text is available yet for this article.
July 3, 2018: JAMA: the Journal of the American Medical Association
Sung Joon Shin, Jae Hang Lee
The Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life came into effect on February 4th, 2018, in South Korea. Based on the Act, all Koreans over the age of 19 years can decide whether to refuse life-sustaining treatments at the end of life via advance directive or physician orders. Hemodialysis is one of the options designated in the Act as a life-sustaining treatment that can be withheld or withdrawn near death. However, hemodialysis has unique features...
June 2018: Kidney Research and Clinical Practice
2018-07-06 09:52:30
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