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Renal Conservative and Palliative Care

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
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 Hemodialysis is one of the options designated in the Act as a life-sustaining treatment that can be withheld or withdrawn near death.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
Wolfgang Pommer
Acute kidney injury (AKI) in the elderly is associated with high risks of chronic kidney disease (CKD), hospital- and all-cause mortality. Based on the decreased renal function in older age groups and age-specific co-morbidity as hypertension, cardiovascular complications, and diabetes mellitus, the risk for AKI is increased. In outpatients inadequate pharmacotherapy and self-medication contribute to increased risk of AKI while in hospital settings severe infection, cardiovascular interventions with contrast media and major surgery may result in higher rates of AKI...
February 2015: Deutsche Medizinische Wochenschrift
Lisa Caulley, Muriel R Gillick, Lisa S Lehmann
New England Journal of Medicine, Volume 378, Issue 24, Page 2339-2341, June 2018.
June 14, 2018: New England Journal of Medicine
Tomoko Terada, Keiko Nakamura, Kaoruko Seino, Masashi Kizuki, Naohiko Inase
Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups. Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed. Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively...
May 2018: Journal of Rural Medicine: JRM
Ann M O'Hare, Susan M Hailpern, Melissa Wachterman, William Kreuter, Ronit Katz, Yoshio N Hall, Maria Montez-Rath, Manjula Kurella Tamura, Kenn B Daratha
Infrequent and late referral to hospice among patients on dialysis likely reflects the impact of a Medicare payment policy that discourages the concurrent receipt of these services, but it may also reflect these patients' less predictable illness trajectories. Among a national cohort of patients on hemodialysis, we identified four distinct spending trajectories during the last year of life that represented markedly different intensities of care. Within the cohort, 9 percent had escalating spending and 13 percent had persistently high spending throughout the last year of life, while 41 percent had relatively low spending with late escalation, and 37 percent had moderate spending with late escalation...
June 2018: Health Affairs
Helen Tam-Tham, Robert R Quinn, Robert G Weaver, Jianguo Zhang, Pietro Ravani, Ping Liu, Chandra Thomas, Kathryn King-Shier, Karen Fruetel, Matt T James, Braden J Manns, Marcello Tonelli, Fliss E M Murtagh, Brenda R Hemmelgarn
Comparisons of survival between dialysis and nondialysis care for older adults with kidney failure have been limited to those managed by nephrologists, and are vulnerable to lead and immortal time biases. So we compared time to all-cause mortality among older adults with kidney failure treated vs. not treated with chronic dialysis. Our retrospective cohort study used linked administrative and laboratory data to identify adults aged 65 or more years of age in Alberta, Canada, with kidney failure (2002-2012), defined by two or more consecutive outpatient estimated glomerular filtration rates less than 10 mL/min/1...
May 23, 2018: Kidney International
Bradley Chen, Chin-Chi Kuo, Nicole Huang, Victoria Y Fan
BACKGROUND: Costs of medical care have been found to be highest at the end of life. AIM: To evaluate the effect of provider reimbursement for hospice care on end-of-life costs. DESIGN: The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life...
May 1, 2018: Palliative Medicine
Manuel Carlos Martins Castro
The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades. Thus, patients on dialysis are becoming more numerous, older and with greater number of comorbidities...
May 17, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Lara Pisani, Nicholas S Hill, Angela Maria Grazia Pacilli, Massimiliano Polastri, Stefano Nava
The genesis of dyspnea involves the activation of several mechanisms that are mediated and perceived depending on previous experiences, values, emotions, and beliefs. Breathlessness may become unbearable, especially in patients who are terminally ill, whether afflicted by respiratory-, cardiac-, or cancer-related disorders, because of a final stage of a chronic process, an acute event, or both. Compared with pain, palliation of dyspnea has received relatively little attention in clinical practice and the medical literature...
April 19, 2018: Chest
Edlyn Gui Fang Tan, Irene Teo, Eric A Finkelstein, Choong Meng Chan
BACKGROUND: In Singapore, most elderly end stage renal disease (ESRD) patients choose dialysis over palliative management. However, dialysis may not be the optimal treatment option given only moderate survival benefits and high costs and treatment burden compared to non-dialysis management. Elderly patients may therefore come to regret this decision. This study investigated (1) extent of patients' decision regret after starting dialysis, and (2) potentially modifiable predictors of regret: satisfaction with chronic kidney disease education, decisional conflict, and decision-making involvement...
May 7, 2018: Nephrology
Peter May, Charles Normand, J Brian Cassel, Egidio Del Fabbro, Robert L Fine, Reagan Menz, Corey A Morrison, Joan D Penrod, Chessie Robinson, R Sean Morrison
Importance: Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. Objective: To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Data Sources: Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation...
June 1, 2018: JAMA Internal Medicine
Melissa W Wachterman, Susan M Hailpern, Nancy L Keating, Manjula Kurella Tamura, Ann M O'Hare
Importance: Patients with end-stage renal disease are less likely to use hospice services than other patients with advanced chronic illness. Little is known about the timing of hospice referral in this population and its association with health care utilization and costs. Objective: To examine the association between hospice length of stay and health care utilization and costs at the end of life among Medicare beneficiaries who had received maintenance hemodialysis...
June 1, 2018: JAMA Internal Medicine
Margaret L Schwarze, Kate Schueller, R Allan Jhagroo
No abstract text is available yet for this article.
June 1, 2018: JAMA Internal Medicine
Vanessa Grubbs
No abstract text is available yet for this article.
May 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Hammad Ali Qazi, Helen Chen, Meng Zhu
BACKGROUND: Research on factors associated with dialysis withdrawal is scarce. This study examined the predictors that might influence rate of dialysis withdrawal. Existing literature is summarized, analyzed and synthesized to identify gaps in the literature with regard to the factors associated with dialysis withdrawal. METHODS: This scoping review used a systematic search to synthesize research findings related to dialysis withdrawal and identified gaps in the literature...
April 24, 2018: BMC Nephrology
Kai-Uwe Eckardt, Nisha Bansal, Josef Coresh, Marie Evans, Morgan E Grams, Charles A Herzog, Matthew T James, Hiddo J L Heerspink, Carol A Pollock, Paul E Stevens, Manjula Kurella Tamura, Marcello A Tonelli, David C Wheeler, Wolfgang C Winkelmayer, Michael Cheung, Brenda R Hemmelgarn
Patients with severely decreased glomerular filtration rate (GFR) (i.e., chronic kidney disease [CKD] G4+) are at increased risk for kidney failure, cardiovascular disease (CVD) events (including heart failure), and death. However, little is known about the variability of outcomes and optimal therapeutic strategies, including initiation of kidney replacement therapy (KRT). Kidney Disease: Improving Global Outcomes (KDIGO) organized a Controversies Conference with an international expert group in December 2016 to address this gap in knowledge...
June 2018: Kidney International
Manjula Kurella Tamura, I-Chun Thomas, Maria E Montez-Rath, Kristopher Kapphahn, Manisha Desai, Randall C Gale, Steven M Asch
Importance: The benefits of maintenance dialysis for older adults with end-stage renal disease (ESRD) are uncertain. Whether the setting of pre-ESRD nephrology care influences initiation of dialysis and mortality is not known. Objective: To compare initiation of dialysis and mortality among older veterans with incident kidney failure who received pre-ESRD nephrology care in fee-for-service Medicare vs the Department of Veterans Affairs (VA). Design, Setting, and Participants: Retrospective cohort study of patients from the US Medicare and VA health care systems evaluated 11 215 veterans aged 67 years or older with incident kidney failure between January 1, 2008, and December 31, 2011...
May 1, 2018: JAMA Internal Medicine
Brian Forzley, Helen H L Chiu, Ognjenka Djurdjev, Rachel C Carson, Gaylene Hargrove, Dan Martinusen, Mohamud Karim
BACKGROUND: Patients with end-stage renal disease (ESRD) frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely share prognostic information with their patients, and how this information guides management. OBJECTIVE: To guide improvements in the management of patients with ESRD, we aimed to better understand how Canadian nephrologists consider prognosis during routine care...
2017: Canadian Journal of Kidney Health and Disease
2018-04-09 08:00:54
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