Delirium in hemodialysis predicts mortality: a single-center, long-term observational study

Yasui‐Furukori, Norio; Tarakita, Natsumi; Uematsu, Waka; Saito, Hisao; Nakamura, Kazuhiko; Οhyama, Chikara; Sugawara, Norio

doi:10.2147/ndt.s152355

Cited by 9 publications

(3 citation statements)

References 30 publications

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“…Fentanyl has the advantage that it has no active metabolites with minimal renal excretion. Haloperidol is recommended for restlessness or agitation due to its safety profile and parenteral route of administration [76]. Nausea can be treated with antipsychotics such as olanzapine or haloperidol [61].…”

Section: End Of Life Carementioning

confidence: 99%

Comprehensive Insights into Palliative Nephrology: A Chapter in Contemporary Renal Medicine

Merchant,

Moideen

2023

Palliative Care - Current Practice and Future Perspectives

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Chronic Kidney disease (CKD) is a global epidemic, affecting more than 800 million people worldwide. Advanced CKD patients experience a substantial symptom burden, compromising their Health-Related Quality of Life. It is crucial for healthcare practitioners to understand the palliative needs of CKD patients, and participate in Advance Care Planning (ACP) and shared decision-making, aligning medical care with patients’ preferences and values. Prognostication tools can help identify those unsuitable for dialysis, leading to consideration of conservative kidney management (CKM), prioritizing supportive care over invasive interventions. Early palliative care referral improves symptom control, patient satisfaction, and goal-concordant care. Symptom management is an important consideration and requires careful consideration of drug dosing and toxicities due to impaired renal function. Dialysis, while extending life, may exacerbate patient suffering; optimizing comfort-oriented therapy can enhance quality of life. End-of-life care, including dialysis withdrawal and hospice care, is a key feature of palliative nephrology, but ethical dilemmas and cultural context must be carefully considered. With an aging CKD population, nephrologists will need to integrate palliative care principles into routine kidney care. This will include improving confidence and competence in providing palliative renal care, and implementing system-level changes to remove barriers to effective palliation and end-of-life care.

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Section: End Of Life Carementioning

confidence: 99%

Comprehensive Insights into Palliative Nephrology: A Chapter in Contemporary Renal Medicine

Merchant,

Moideen

2023

Palliative Care - Current Practice and Future Perspectives

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“…Haloperidol has a better safety profile and can be administered parenterally. [ 25 ] In patients with refractory symptoms an attempt is made to lower the consciousness intentionally using a titrated and monitored dose of nonopioid drugs to relieve distress of symptoms. It is known as palliative sedation and commonly drugs like midazolam and phenobarbitone are used.…”

Section: E Nd Of L Ife C Are In E Nd -S Tage mentioning

confidence: 99%

End of life care in end-stage kidney disease

Prabhu¹,

Salins²,

Bharathi³

et al. 2021

Indian J Palliat Care

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There is a rise in burden of end-stage renal disease globally and in India. The symptom burden, prognosis, and mortality in chronic kidney disease closely mimics that of cancer. However, the palliative and end of life care needs of these patients are seldom addressed. A consensus opinion statement was developed outlining the provision of end of life care in end-stage kidney disease. Recognition of medical futility, consensus on medical futility, and cessation of potentially inappropriate therapies and medications are the initial steps in providing end of life care. Conducting a family meeting, communicating prognosis, discussing various treatment modalities, negotiating goals of care, shared decision-making, and discussion and documentation of life sustaining treatment are essential aspects of end of life care provision. The provision of end of life care entails assessment and the management of end-stage kidney disease symptoms and the care extends beyond the death of the patient to their families in the bereavement period.

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“…The mortality rate in adults with CKD is approximately 10% to 15% worldwide, and it is 2- to 4-fold higher than the rate in those without CKD. [ 3 ] In a recent study by Lo et al, end-stage renal failure requiring dialysis was an independent risk factor for 1-year mortality after hip fracture surgery. [ 4 ] Indeed, osteoporotic hip fractures related to CKD were associated with high mortality and morbidity, with rates up to 30% in elderly patients, [ 5 – 8 ] while mineral and bone disorders were associated with an increased risk of cardiovascular and valvular calcification, arterial stiffness, hypertension, and sudden death.…”

Section: Introductionmentioning

confidence: 99%

Effect of renal dialysis on mortality and complications following hip fracture surgery in elderly patients

Ahn

Bang

2020

Medicine

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Hip fractures in older patients requiring dialysis are associated with high mortality. The primary aim of this study was to evaluate the specific burden of dialysis on 30-day mortality following hip fracture surgery. The secondary aim was to determine the burden of dialysis on overall survival as well as several postoperative complications. A retrospective cohort study was conducted using data from the Korean National Health Insurance Research Database. Patients were aged ≥65 years and underwent hip fracture surgery during the period from 2009 to 2015. To construct a matched cohort, each dialysis patient was matched to 4 non-dialysis patients based on age, sex, hospital type, anesthesia type, and comorbidities. Survival status was determined 30 days after surgery and at the end of the study period. In total, 96,289 patients were identified. Among them, 1614 dialysis patients were included and matched to 6198 non-dialysis patients. During the 30-day postoperative period, there were 102 mortality events in the dialysis group and 127 in the non-dialysis group, for an adjusted hazard ratio of 3.12 (95% confidence interval, 2.42–4.09). Overall, by the end of the study period, there were 1120 mortality events in the dialysis group and 2731 in the non-dialysis group, for an adjusted hazard ratio of 1.97 (95% confidence interval, 1.83–2.1). These findings may be limited by the characteristics of the administrative database. The 30-day mortality rate was 3-fold higher in the dialysis group than in the non-dialysis group, while the overall mortality rate was approximately 2-fold higher in the dialysis group than in the non-dialysis group. These findings suggest that caution in the perioperative period is required in dialysis patients undergoing hip fracture surgery. The results of our study represent only an association between dialysis and mortality. Further studies are necessary to investigate the possible causal effect of dialysis on mortality and complications after hip fracture surgery.

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Delirium in hemodialysis predicts mortality: a single-center, long-term observational study

Cited by 9 publications

References 30 publications

Comprehensive Insights into Palliative Nephrology: A Chapter in Contemporary Renal Medicine

Comprehensive Insights into Palliative Nephrology: A Chapter in Contemporary Renal Medicine

End of life care in end-stage kidney disease

Effect of renal dialysis on mortality and complications following hip fracture surgery in elderly patients

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