Supportive Care: Integration of Patient-Centered Kidney Care to Manage Symptoms and Geriatric Syndromes

Davison, Sara N.; Jassal, Sarbjit V.

doi:10.2215/cjn.01050116

Cited by 68 publications

(88 citation statements)

References 70 publications

(71 reference statements)

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“…Where reported, there was a considerable increase in symptoms in the month before death (30). Evidence on management of symptoms is the accompanying articles by Davison and Jassal in this Moving Points feature (34). Three of the studies (16,31,33) included a comparison group.…”

Section: What Are Symptoms Quality Of Life and Illness Experiences mentioning

confidence: 99%

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

Murtagh¹,

Burns²,

Moranne³

et al. 2016

CJASN

118

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Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care.

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Section: What Are Symptoms Quality Of Life and Illness Experiences mentioning

confidence: 99%

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

Murtagh¹,

Burns²,

Moranne³

et al. 2016

CJASN

118

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“…The growth in the prevalent dialysis population has been driven mainly by increases in longevity. 1,2 Consequently, appropriate use of conservative care for end-stage renal disease (ESRD), [3][4][5][6] palliative care in nephrology, [7][8][9][10][11][12] and elective withdrawal from dialysis [13][14][15][16][17][18][19] are issues currently engaging the nephrology community.…”

Section: Introductionmentioning

confidence: 99%

Early withdrawal and non‐withdrawal death in the months following hemodialysis initiation: A retrospective cohort analysis

Wetmore

Roetker

Gilbertson

et al. 2019

Hemodialysis International

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Introduction: Whether and how factors associated with elective hemodialysis withdrawal differ from those associated with non‐withdrawal death soon after maintenance hemodialysis initiation have not been well studied. Methods: A retrospective cohort analysis was performed using USRDS data from 2011 to 2014. Patients were randomly categorized 2:1 into training and validation samples. Elective withdrawal deaths were identified using the Death Notification form. Multinomial logistic regression was used to fit a prediction model for three outcome categories (withdrawal, non‐withdrawal death, survival at 6 months) as a function of demographic, comorbidity, and functional status. Findings: The training sample comprised 80,284 hemodialysis patients. Mean age was 71.7 ± 11.4 years, 44.9% were female, 72.9% were white, and 22.8% were black. Within 6 months, 19.1% died, of whom 2099 (2.6%) withdrew and 13,223 (16.5%) died of a non‐withdrawal cause; 13.7% of all deaths were withdrawals. Baseline characteristics and event rates were similar among the 40,142 patients in the validation sample. The model was calibrated adequately and could discriminate moderately well between withdrawal and survival (area under ROC curve [AUC]: 0.77) and between non‐withdrawal death and survival (AUC: 0.73). However, discrimination between withdrawal and non‐withdrawal death was relatively low (AUC: 0.62). Older age and white, compared with non‐white, race were each associated with greater odds of death, and these associations were stronger for withdrawal than for non‐withdrawal death. Discussion: Advanced age and white, as opposed to black, race were most strongly associated with early elective hemodialysis withdrawal compared with non‐withdrawal death. However, it is difficult to differentiate between patients who will experience early withdrawal vs. non‐withdrawal death, as many factors are similarly associated with both outcomes.

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“…Therefore, patients with ESRD benefit from a palliative care approach that focuses on symptom relief and aims to improve their quality of life. To emphasise that palliative care is not just restricted to end‐of‐life care, the term kidney supportive care has been introduced and this can be provided with therapies that are intended to prolong life .…”

Section: What Can We Learn From Palliative Care For Adults With Chronmentioning

confidence: 99%

Supportive palliative care should be integrated into routine care for paediatric patients with life‐limiting kidney disease

et al. 2017

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Supportive Care: Integration of Patient-Centered Kidney Care to Manage Symptoms and Geriatric Syndromes

Cited by 68 publications

References 70 publications

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

Early withdrawal and non‐withdrawal death in the months following hemodialysis initiation: A retrospective cohort analysis

Supportive palliative care should be integrated into routine care for paediatric patients with life‐limiting kidney disease

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