Palliative care for advanced renal disease:  A summary of the evidence and future direction

Kane, Pauline; Vinen, Katie; Murtagh, Fliss E.M.

doi:10.1177/0269216313491796

Cited by 50 publications

(48 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A few studies have addressed symptoms in elderly dialysis or nondialysis patients with CKD and have shown a high symptom burden in all cases, often analogous to the burden carried by patients with cancer (8,36). O'Connor and Kumar (27) found only six studies of symptom burden or QOL in patients managed without dialysis, with a mean 7-17 symptoms, similar to our mean of 12.…”

Section: Symptom Control and Qolsupporting

confidence: 68%

CKD in Elderly Patients Managed without Dialysis

Brown

Collett

Josland

et al. 2015

Clinical Journal of the American Society of Nephrology

188

229

View full text Add to dashboard Cite

Background and objectives Survival, symptom burden, and quality of life (QOL) are uncertain for elderly patients with advanced CKD managed without dialysis. We examined these outcomes in patients managed with renal supportive care without dialysis (RSC-NFD) and those planned for or commencing dialysis.Design, setting, participants, & measurements In this prospective observational study, symptoms were measured using the Memorial Symptom Assessment Scale and the Palliative care Outcomes Scale -Symptoms (renal) inventory and QOL was measured using the Short Form-36 survey. This study comprised 273 predialysis patients who had usual nephrology care and 122 nondialysis pathway patients who also attended a renal supportive care clinic adding the skills of a palliative medicine team. A further 72 patients commenced dialysis during this period without attending either clinic.Results Nondialysis patients were older than the predialysis group (82 versus 67 years; P,0.001) but had similar eGFR at the first clinic visit (16 ml/min per 1.73 m 2 ; P=0.92). Of the predialysis patients, 92 (34%) commenced dialysis. Compared with the RSC-NFD group, the death rate was lower in the predialysis group who did not require dialysis (hazard ratio, 0.23; 95% confidence interval, 0.12 to 0.41] and in those requiring dialysis (0.30; 0.13 to 0.67) but not in dialysis patients who had not attended the predialysis clinic (0.60; 0.35 to 1.03). Median survival in RSC-NFD patients was 16 (interquartile range, 9, 37) months and 32% survived .12 months after eGFR fell below 10 ml/min per 1.73 m 2 . For the whole group, age, serum albumin, and eGFR ,15 ml/min per 1.73 m 2 were associated with poorer survival. Of the nondialysis patients, 57% had stable or improved symptoms over 12 months and 58% had stable or improved QOL.Conclusions Elderly patients who choose not to have dialysis as part of shared decision making survive a median of 16 months and about one-third survive 12 months past a time when dialysis might have otherwise been indicated. Utilizing the skills of palliative medicine helps provide reasonable symptom control and QOL without dialysis.

show abstract

Section: Symptom Control and Qolsupporting

confidence: 68%

CKD in Elderly Patients Managed without Dialysis

Brown

Collett

Josland

et al. 2015

Clinical Journal of the American Society of Nephrology

188

229

View full text Add to dashboard Cite

show abstract

“…(8,42,43) Some patients suggested that the PCP might be the best person to lead ACP discussions. Preferences discussed with the PCP could then be shared with the dialysis team in an integrated care model.…”

Section: Discussionmentioning

confidence: 99%

Advance Care Planning

Goff

Eneanya

Feinberg

et al. 2015

Clinical Journal of the American Society of Nephrology

102

View full text Add to dashboard Cite

Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients' and families' diverse needs can strengthen systematic efforts to improve ACP.Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes.Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, "Prior experiences with ACP," revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, "Factors that may affect perspectives on ACP," included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, "Recommendations for discussing ACP," included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how.Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may affect patient perspectives regarding ACP. This study's findings may inform clinical practice and will be useful in designing prospective intervention studies to improve patient and family experiences at the end of life.

show abstract

“…25 The UK Renal Registry does not currently collect data on patients who choose conservative management or who have stable CKD stage V. However, a number of smaller studies have compared outcomes for these patients. 6,21,[27][28][29][30][31][32][33][34] Taken as a whole, patients who choose to dialyse do, generally, live longer that those who choose conservative management, although it does vary quite significantly from study to study, depending in part on definition of conservative management used. However, they also spend much more time in hospital (including dialysis attendances) 28 and frequently report that they are so exhausted after a dialysis session that they cannot even manage to prepare a meal.…”

Section: -24mentioning

confidence: 99%