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Medline ® Abstracts for References 1-8

of 'Palliative care: End-stage renal disease'

1
TI
Palliative care.
AU
Moss AH, Holley JL, Davison SN, Dart RA, Germain MJ, Cohen L, Swartz RD
SO
Am J Kidney Dis. 2004;43(1):172.
 
AD
Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA. amoss@hsc.wvu.edu
PMID
2
TI
Supportive care for the renal patient.
AU
Levy JB, Chambers EJ, Brown EA
SO
Nephrol Dial Transplant. 2004;19(6):1357.
 
AD
PMID
3
TI
Octogenarians and nonagenarians starting dialysis in the United States.
AU
Kurella M, Covinsky KE, Collins AJ, Chertow GM
SO
Ann Intern Med. 2007;146(3):177.
 
BACKGROUND: The elderly constitute the fastest-growing segment of the end-stage renal disease (ESRD) population, but the epidemiology and outcomes of dialysis among the very elderly, that is, those 80 years of age and older, have not been previously examined at a national level.
OBJECTIVE: To describe recent trends in the incidence and outcomes of octogenarians and nonagenarians starting dialysis.
DESIGN: Observational study.
SETTING: U.S. Renal Data System, a comprehensive, national registry of patients with ESRD.
PARTICIPANTS: Octogenarians and nonagenarians initiating dialysis between 1996 and 2003.
MEASUREMENTS: Rates of dialysis initiation and survival.
RESULTS: The number of octogenarians and nonagenarians starting dialysis increased from 7054 persons in 1996 to 13,577 persons in 2003, corresponding to an average annual increase in dialysis initiation of 9.8%. After we accounted for population growth, the rate of dialysis initiation increased by 57% (rate ratio, 1.57 [95% CI, 1.53 to 1.62]) between 1996 and 2003. One-year mortality for octogenarians and nonagenarians after dialysis initiation was 46%. Compared with octogenarians and nonagenarians initiating dialysis in 1996, those starting dialysis in 2003 had a higher glomerular filtration rate and less morbidity related to chronic kidney disease but no difference in 1-year survival. Clinical characteristics strongly associated with death were older age, nonambulatory status, and more comorbid conditions.
LIMITATIONS: Survival of patients with incident ESRD who did not begin dialysis could not be assessed.
CONCLUSIONS: The number of octogenarians and nonagenarians initiating dialysis has increased considerably over the past decade, while overall survival for patients on dialysis remains modest. Estimates of prognosis based on patient characteristics, when considered in conjunction with individual values and preferences, may aid in dialysis decision making for the very elderly.
AD
Division of Nephrology, University of California, San Francisco, CA 94118-1211, USA. manjula.kurella@ucsf.edu
PMID
4
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Renal palliative care.
AU
Cohen LM, Moss AH, Weisbord SD, Germain MJ
SO
J Palliat Med. 2006;9(4):977.
 
Patients with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Clinicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.
AD
Renal Palliative Care Initiative, Baystate Medical Center, Springfield, Massachusetts 01199, USA. lewis.cohen@bhs.org
PMID
5
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Palliative care in end-stage renal disease: illness trajectories, communication, and hospice use.
AU
Holley JL
SO
Adv Chronic Kidney Dis. 2007;14(4):402.
 
Palliative care is comprehensive, interdisciplinary care focusing on pain and symptom management, advance-care planning and communication, psychosocial and spiritual support, and, in end-stage renal disease (ESRD), the ethical issues in dialysis decision making. End-of-life care is one aspect of palliative care and incorporates all of the previously mentioned components as well as hospice and bereavement care. ESRD patients and their families are appropriate candidates for palliative care because of their high symptom burden, shortened survival, and significant comorbidity. The usual pattern of illness trajectory in ESRD is a progressive decline punctuated by episodes of acute deterioration prompted by sentinel events like limb amputation or myocardial infarction. Such events provide opportunities for advance-care planning and communication between providers and patients and families. Although communication is an integral component of palliative care, little is understood about effective provider-patient communication, especially in estimating and discussing prognosis. Palliative care has much to offer toward improving the quality of dialysis patients' lives as well as planning for and improving the quality of their deaths. The palliative care issues of illness trajectory, communication, and hospice use among ESRD patients will be reviewed.
AD
Department of Medicine, University of Illinois, Urbana-Champaign, and Carle Clinic, Urbana, IL 61801, USA. jean.holley@carle.com
PMID
6
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Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis.
AU
Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K
SO
Clin J Am Soc Nephrol. 2012;7(12):2002. Epub 2012 Sep 6.
 
BACKGROUND AND OBJECTIVES: Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis.
DESIGN, SETTING, PARTICIPANTS,&MEASUREMENTS: Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5).
RESULTS: After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR±SD was similar (14.0±4.0 ml/min per 1.73 m(2)) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scoreswere similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients.
CONCLUSIONS: Patients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.
AD
Lister Renal Unit, Stevenage, Herts, United Kingdom.
PMID
7
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A patient-centered vision of care for ESRD: dialysis as a bridging treatment or as a final destination?
AU
Vandecasteele SJ, Kurella Tamura M
SO
J Am Soc Nephrol. 2014 Aug;25(8):1647-51. Epub 2014 May 15.
 
The ESRD population is heterogeneous, including patients without severe comorbidity for whom dialysis is a bridge to transplantation or a long-term maintenance treatment, as well as patients with a limited life expectancy as a result of advanced age or severe comorbidity for whom dialysis will be the final treatment destination. The complex medical and social context of this latter group fits poorly in the homogeneous, disease-centered, and process-driven approach of many clinical practice guidelines for dialysis. In this commentary, we argue that the standards of treatment allocated to each individual patient should be defined not merely by his or her disease state, but also by his or her preferences and prognosis. In this more patient-centered approach, three attainable treatment goals with a corresponding therapeutic approach could be defined: (1) dialysis as bridging or long-term maintenance treatment, (2) dialysis as final treatment destination, and (3) active medical management without dialysis. For patients with a better overall prognosis, this approach will emphasize complication prevention and long-term survival. For patients with a limited overall prognosis, strictly disease-centered interventions often impose a treatment burden that does not translate into a proportional improvement in quantity or quality of life. For these patients, a patient-centered approach will place more emphasis on palliative management strategies that are less disease specific.
AD
Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium; Stefaan.Vandecasteele@azbrugge.be.
PMID
8
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Patient-centered care: an opportunity to accomplish the "Three Aims" of the National Quality Strategy in the Medicare ESRD program.
AU
O'Hare AM, Armistead N, Schrag WL, Diamond L, Moss AH
SO
Clin J Am Soc Nephrol. 2014;9(12):2189. Epub 2014 Jul 17.
 
In light of mounting federal government debt and levels of Medicare spending that are widely viewed as unsustainable, commentators have called for a transformation of the United States health care system to deliver better care at lower costs. This article presents the priorities of the Coalition for Supportive Care of Kidney Patients for how clinicians might achieve this transformation for patients with advanced CKD and their families. The authors suspect that much of the high-intensity, high-cost care currently delivered to patients with advanced kidney disease may be unwanted and that the "Three Aims" put forth by the National Quality Strategy of better care for the individual, better health for populations, and reduced health care costs may be within reach for patients with CKD and ESRD. This work describes the coalition's vision for a more patient-centered approach to the care of patients with kidney disease and argues for more concerted efforts to align their treatments with their goals, values, and preferences. Key priorities to achieve this vision include using improved prognostic models and decision science to help patients, their families, and their providers better understand what to expect in the future; engaging patients and their families in shared decision-making before the initiation of dialysis and during the course of dialysis treatment; and tailoring treatment strategies throughout the continuum of their care to address what matters most to individual patients.
AD
Department of Medicine, University of Washington and Veterans Affairs Puget Sound Healthcare System, Seattle, Washington;
PMID