Trajectories of Illness in Stage 5 Chronic Kidney Disease

Murtagh, Fliss E.M.; Sheerin, Neil; Addington‐Hall, Julia; Higginson, Irene J

doi:10.2215/cjn.09021010

Cited by 108 publications

(96 citation statements)

References 56 publications

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“…37 A second study of conservative management found an increase in symptom distress and health related concerns in the last two months of life. 38 The findings presented on QOL are limited and preliminary. The included studies compare small groups of patients, and the results are not stratified by age or comorbidities to allow more precise determination of which patients benefit from dialysis in terms of QOL.…”

Section: Discussionmentioning

confidence: 95%

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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Section: Discussionmentioning

confidence: 95%

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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“…11,12 In conservatively managed Stage 5 chronic kidney disease (CKD), symptom scores and functional status can often be relatively stable until 1-2 months preceding death. This is in marked contrast to trajectories for cancer patients or those with chronic obstructive pulmonary disease (COPD) or cardiac failure.…”

Section: Introduction -The Distinctive Features Of Renal Palliative Carementioning

confidence: 99%

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

2013

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Background: Patients with end-stage kidney disease can have a significant symptom burden with complex co-morbidities. Compounding this is the choice between dialysis and conservative management. Need for supportive and palliative care: For individuals with end-stage kidney disease, palliative care can provide support with symptom management, advance care planning and psychological support and education for both patients and their families. Optimum management may be achieved through collaboration between renal and palliative care professionals, combining their different skills in addressing symptom and medication management. Palliative and supportive care must be patient-centred to be effective. Multidisciplinary cross-organisational input is central to address the complex care needs of these patients, particularly for those in the community. What is known/what is not known:There is growing awareness of the need for research into the palliative care needs of those with end-stage kidney disease. Research has shown that patients receiving dialysis may prioritise quality of life over survival time, partly due to the constraints that they feel dialysis imposes on them. Systematic study of those opting for a conservative management pathway rather than dialysis is beginning to happen. Research implications:Research is required into what underpins the preferences and priorities of patients with end-stage kidney disease to provide them with the best palliative and supportive care. Policy and practice: As more patients opt to follow the conservative pathway for their advanced renal disease, a change in service provision is required, with greater regular inclusion of palliative and supportive needs to address the gap in the care provision for this growing group.

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“…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: 92%

“…Murtagh et al studied symptoms before death in 74 patients with CKD stage 5 in whom dialysis was not initiated (76,77). Symptoms were similar to those in patients with end-stage cancer (76).…”

Section: Palliative Care and Hospicementioning

confidence: 99%

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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Trajectories of Illness in Stage 5 Chronic Kidney Disease

Cited by 108 publications

References 56 publications

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

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

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

Renal Replacement Therapy in the Elderly Population

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