Palliative Care in Kidney Disease

Murtagh, Fliss

doi:10.1007/978-3-319-31738-0_63-1

Cited by 2 publications

(3 citation statements)

References 55 publications

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“…The authors are not aware of any published guidance on pain management in this group. Therefore, the following guidance extrapolates from first principles and existing literature pertaining to the management of pain in patients with severe and end stage renal impairment but taking into account the unique challenge that calciphylaxis presents in terms of the severity of the pain as described by the physicians surveyed in this paper and the potential for opioid toxicity described by survey respondents as well as the expert opinion of the authors who are palliative medicine physicians (one working in renal palliative care) and renal physicians (one with an expertise in calciphylaxis) [ 16 , 17 ].…”

Section: Recommendationsmentioning

confidence: 99%

Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

et al. 2020

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Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline. Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time. Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

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Section: Recommendationsmentioning

confidence: 99%

Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

et al. 2020

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“…The authors recognise that opioids are not considered appropriate for chronic pain. However, this is an acute pain arising in response to tissue injury and death (17) and therefore, we recommend an opioid as rst line therapy.…”

Section: Background Pain Controlmentioning

confidence: 99%

“…The authors recommend alfentanil as it is not removed by dialysis, it does not cause toxicity in an ESRD population and it occupies a low volume in syringe drivers. This guidance is drawn from literature on the use of opioids in cancer patients with severe and end stage terminal illness (18)(19)(20) and is supported by the clinical pharmacology literature (17). Fentanyl by CSCI is an alternative.…”

Section: Background Pain Controlmentioning

confidence: 99%

Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations

Chinnadurai

Sinha

Lowney

et al. 2020

Preprint

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Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.MethodsAn online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. ResultsOne hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.ConclusionThere was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

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Palliative Care in Kidney Disease

Cited by 2 publications

References 55 publications

Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations

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