Symptoms in the Month Before Death for Stage 5 Chronic Kidney Disease Patients Managed Without Dialysis

Murtagh, Fliss E.M.; Addington‐Hall, Julia; Edmonds, Polly; Donohoe, Paul; Carey, Ivana; Jenkins, Karen; Higginson, Irene J

doi:10.1016/j.jpainsymman.2010.01.021

Cited by 120 publications

(96 citation statements)

References 37 publications

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“…By the month before death, prevalence had increased to lack of energy (86%), pruritus (84%), drowsiness (82%), dyspnea (80%), pain (73%), and restless legs (65%), and nausea had also become prevalent (59%). Full details of these cross-sectional analyses are reported elsewhere (22,23). Table 2 provides details of the change in symptoms between baseline and the month before death.…”

Section: Common Symptomsmentioning

confidence: 99%

Trajectories of Illness in Stage 5 Chronic Kidney Disease

Murtagh

Sheerin

Addington‐Hall

et al. 2011

Clinical Journal of the American Society of Nephrology

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107

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SummaryBackground and objectives The illness trajectory in the last year of life in advanced (stage 5) chronic kidney disease is poorly understood. Mapping the trajectory of patient-centered outcomes could facilitate better care. The objectives of this study were to determine trajectories of symptoms and wider health-related concerns in the last year of life in stage 5 chronic kidney disease, managed without dialysis.Design, setting, participants, & measurements A longitudinal symptom survey in three UK renal units was used, using the Memorial Symptom Assessment Scale-Short Form and core Palliative Care Outcome Scale. Average (using mean scores over time) and individual (using individual scores over time, with visual graphical analysis) trajectories were mapped.Results Seventy-four patients (mean age, 81 Ϯ 6.8 years) were recruited; 49 died during follow-up. Average trajectories showed moderate symptom distress and health-related concerns, with marked increase in the last 2 months of life. Visual graphical analysis enabled stable, increasing, or fluctuant individual trajectories to be identified. The proportion following these trajectories varied between outcome measures; regarding symptoms, 50% followed a stable pattern, 24% increased, and 21% fluctuated compared with 26%, 57%, and 21%, respectively, for health-related concerns. Inter-rater agreement in grouping trajectories was high ( statistic, 0.80 and 0.86, respectively). ConclusionsIn the 2 months before death, patients reported a sharp increase in symptom distress and health-related concerns. Health care should anticipate and address this increase, which may indicate the patients is approaching death. Considerable individual variation and flexibility/responsiveness of care is important: one size of service does not fit all.

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Section: Common Symptomsmentioning

confidence: 99%

Trajectories of Illness in Stage 5 Chronic Kidney Disease

Murtagh

Sheerin

Addington‐Hall

et al. 2011

Clinical Journal of the American Society of Nephrology

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107

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“…Three studies [22][23][24] utilized the Memorial Symptom Assessment Scale Short Form (MSAS-SF) to collect data on the prevalence of various symptoms; one study 25 used a modified version of the Patient Outcome Scale Symptom Module (POSs). Both the MSAS-SF and the POSs have been validated for use in palliative care populations.…”

mentioning

confidence: 99%

Conservative Management of End-Stage Renal Disease without Dialysis: A Systematic Review

O’Connor¹,

Kumar

2012

Journal of Palliative Medicine

205

183

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Purpose: To summarize evidence on conservative, nondialytic management of end-stage renal disease regarding 1) prognosis and 2) symptom burden and quality of life (QOL). Methods: Medline, Cinahl, and Cochrane were searched for records indexed prior to March 1, 2011. Bibliographies of articles and abstracts from recent meetings were reviewed. Authors and nephrologists were contacted to identify additional studies. Articles were reviewed by two authors and selected if they described stage 5 chronic kidney disease (CKD) patients managed without dialysis, including one or more of the following outcomes: prognosis, symptoms, or QOL. Levels of evidence ratings were assigned using the SORT (Strength of Recommendation Taxonomy) system. Data was abstracted independently by two authors for descriptive analysis. Results: Thirteen studies were included. In studies of prognosis, conservative management resulted in median survival of at least six months (range 6.3 to 23.4 months). Findings are mixed as to whether dialysis prolongs survival in the elderly versus conservative, nondialytic management. Any survival benefit from dialysis decreases with comorbidities, especially ischemic heart disease. Patients managed conservatively report a high symptom burden, underscoring the need for concurrent palliative care. Additional head-to-head studies are needed to compare the symptoms of age-matched dialysis patients, but preliminary studies suggest that QOL is similar. Conclusions: Conservative management is an important alternative to discuss when counseling patients and families about dialysis. Unlike withdrawal of dialysis in which imminent death is expected, patients who decline dialysis initiation can live for months to years with appropriate supportive care.

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“…Symptoms were similar to those in patients with end-stage cancer (76). Degree of distress correlated with frequency, except for dyspnea (76).…”

Section: Palliative Care and Hospicementioning

confidence: 54%

“…Symptoms were similar to those in patients with end-stage cancer (76). Degree of distress correlated with frequency, except for dyspnea (76). A sharp increase in distress and health-related concerns occurred 2 months before death (77).…”

Section: Palliative Care and Hospicementioning

confidence: 62%

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Renal Replacement Therapy in the Elderly Population

Berger¹,

Hedayati

2012

Clinical Journal of the American Society of Nephrology

100

101

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Summary ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.

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Symptoms in the Month Before Death for Stage 5 Chronic Kidney Disease Patients Managed Without Dialysis

Cited by 120 publications

References 37 publications

Trajectories of Illness in Stage 5 Chronic Kidney Disease

Trajectories of Illness in Stage 5 Chronic Kidney Disease

Conservative Management of End-Stage Renal Disease without Dialysis: A Systematic Review

Renal Replacement Therapy in the Elderly Population

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