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By Erica Yama Nephrologist
Ken Farrington, Adrian Covic, Fillipo Aucella, Naomi Clyne, Leen de Vos, Andrew Findlay, Denis Fouque, Tomasz Grodzicki, Osasuyi Iyasere, Kitty J Jager, Hanneke Joosten, Juan Florencio Macias, Andrew Mooney, Dorothea Nitsch, Marijke Stryckers, Maarten Taal, James Tattersall, Dieneke Van Asselt, Nele Van den Noortgate, Ionut Nistor, Wim Van Biesen
No abstract text is available yet for this article.
November 2016: Nephrology, Dialysis, Transplantation
Anne-Cécile Rouveure, Marc Bonnefoy, Maurice Laville
Hemodialysis is the predominant replacement therapy in the 70 year-old French population (18% in peritoneal dialysis, 72% in hemodialysis from the REIN registry). Managing older patients reaching the end stage renal disease poses many ethical questions, since outcomes balanced regarding survival and quality of life. The aim of this study was to compare the survival of patients aged over 70 years according to the ESRD treatment choice: conservative treatment without dialysis (CT), hemodialysis (HD) and peritoneal dialysis (PD)...
February 2016: Néphrologie & Thérapeutique
Holly M Koncicki, Jane O Schell
Elderly patients comprise the most rapidly growing population initiating dialysis therapy and may derive particular benefit from comprehensive assessment of geriatric syndromes, coexisting comorbid conditions, and overall prognosis. Palliative care is a philosophy that aims to improve quality of life and assist with treatment decision making for patients with serious illness such as kidney disease. Palliative skills for the nephrology provider can aid in the care of these patients. This review provides nephrology providers with 4 primary palliative care skills to guide treatment decision making: (1) use prognostic tools to identify patients who may benefit from conservative management, (2) disclose prognostic information to patients who may not do well with dialysis therapy, (3) incorporate patient goals and values to outline a treatment plan, and (4) prepare patients and families for transitions and end of life...
April 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Joseph R Berger, Vishal Jaikaransingh, S Susan Hedayati
The number of patients with end-stage kidney disease 65 years and older is growing, and this growth is expected to continue. The presence of medical comorbidities, limited life expectancy, frailty, and poor functional status in these patients poses substantial challenges in clinical decision-making and provision of optimal care. Frailty is more common in elderly patients with CKD than without and is associated with poor outcomes. Several prognostic tools were developed to estimate the rate of CKD progression among elderly, and risk of mortality after dialysis initiation...
January 2016: Advances in Chronic Kidney Disease
Celine Foote, Rachael L Morton, Meg Jardine, Martin Gallagher, Mark Brown, Kirsten Howard, Alan Cass
BACKGROUND: Nephrologists often face difficult decisions when recommending dialysis or non-dialysis (supportive) care for elderly patients, given the uncertainty around survival and the burden of dialysis. Discrete choice experiments (DCEs) mimic real-world decisions through simultaneous consideration of multiple variables. We aimed to determine the relative influence of patient characteristics on dialysis recommendations. METHODS: We conducted a DCE among Australasian nephrologists consisting of 12 scenarios of two patients (described in terms of age, gender, cognition, comorbidity, life expectancy, current quality of life (QOL), expected QOL with dialysis, social support, patient and family inclination)...
December 2014: Nephrology, Dialysis, Transplantation
Eric A Coleman, Carla Parry, Sandra Chalmers, Sung-Joon Min
BACKGROUND: Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates. METHODS: Randomized controlled trial. Between September 1, 2002, and August 31, 2003, patients were identified at the time of hospitalization and were randomized to receive the intervention or usual care...
September 25, 2006: Archives of Internal Medicine
Jane O Schell, Robert A Cohen
Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented...
November 7, 2014: Clinical Journal of the American Society of Nephrology: CJASN
Jean L Holley, Sara N Davison
No abstract text is available yet for this article.
May 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Marcello Tonelli, Miguel C Riella
No abstract text is available yet for this article.
March 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Pooja Singh, Michael J Germain, Lewis Cohen, Mark Unruh
The burgeoning population of older dialysis patients presents opportunities to provide personalized care. The older dialysis population has a high burden of chronic health conditions, decrements in quality of life and a high risk of death. In order to address these challenges, this review will recommend routinely establishing prognosis through the use of prediction instruments and communicating these findings to older patients. The challenges to prognosis in adults with end-stage renal disease (ESRD) include the subjective nature of clinical judgment, application of appropriate prognostic tools and communication of findings to patients and caregivers...
May 2014: Nephrology, Dialysis, Transplantation
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