Palliative care for patients with end-stage renal disease: approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses

Abstract

Providing end-of-life care to patients suffering from chronic kidney disease (CKD) and/or end-stage renal disease often presents ethical challenges to families and health care providers. However, as the conditions these patients present with are multifaceted in nature, so should be the approach when determining prognosis and treatment strategies for this patient population. Having an interdisciplinary palliative team in place to address any concerns that may arise during conversations related to end-of-life care encourages effective communication between the patient, the family and the medical team. Through the use of a case study, the authors demonstrate how an interdisciplinary palliative team can be used to make decisions that satisfy the patient's and the medical team's desires for end-of-life care.

Hemodialysis as a life-sustaining treatment at the end of life

“…If there is any uncertainty in prognosis and no consensus is reached related to dialysis, then a time-limited trial of dialysis may be provided [ 4 ]. Palliative care should be considered for patients suffering from disease complications at any EoL stage [ 45 ]. A multidisciplinary care team is necessary to provide physical, psychosocial, religious, and spiritual support for ESRD patients who opt out of or refuse dialysis.…”

Taiwan renal care system: A learning health‐care system

“…Many patients who received dialysis also suffer from multiple comorbidities, and 1‐year mortality rates following initiation of dialysis are 22–24% in patients 75 years or older. Dialysis patients are often reported to feel less independent, to be less able to participate in social activities and have an overall decline in functional status and quality of life . In order to fill this gap of renal care, end‐of‐life care has been considered by encouraging effective communication between the patient, the family and the medical team to offer symptoms relief and optimize the quality of life.…”

“…Dialysis patients are often reported to feel less independent, to be less able to participate in social activities and have an overall decline in functional status and quality of life. 19 In order to fill this gap of renal care, end-of-life care has been considered by encouraging effective communication between the patient, the family and the medical team to offer symptoms relief and optimize the quality of life. In addition, the 'Hospice Palliative Care Regulation Amendment' and 'Patient's Self-determination Right Act, Taiwan' will also give a big support to the end-of-life care.…”

Palliative Care and Advance Care Planning in Pulmonary Hypertension

“…This finding is mirrored in other specialties dealing with life-limiting illnesses including oncology, cardiology, and nephrology. 29,30 A large part of this low number is driven by the physician's own discomfort at having these conversations. Many physicians report being concerned that discussions centered on disease progression and end-of-life wishes may distress their patients or cause them to "give up," despite the fact that studies have shown evidence to the contrary 31,32 ; several studies centered on open communication in advanced cancer patients revealed that all patients reported wanting honesty from their providers, as well as some indication of their overall prognosis.…”