Unique palliative care needs of patients with advanced chronic kidney disease – the scope of the problem and several solutions
Patients with advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD), have a life-threatening illness complicated by high morbidity and mortality and, therefore, should be suitable candidates for early intervention by palliative care specialists. However, the average patient...
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| Published in | Clinical medicine (London, England) Vol. 19; no. 1; pp. 26 - 29 |
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| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.01.2019
Royal College of Physicians |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Patients with advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD), have a life-threatening illness complicated by high morbidity and mortality and, therefore, should be suitable candidates for early intervention by palliative care specialists. However, the average patient with CKD does not have an advanced care plan, has multiple debilitating symptoms, and does not utilise hospice care at the end of life. In this review, we outline the scope of the problem of unmet palliative care needs for patients with advanced CKD and ESRD, barriers to improving palliative care for patients with renal failure, and possible future directions for palliative nephrology. |
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| AbstractList | Patients with advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD), have a life-threatening illness complicated by high morbidity and mortality and, therefore, should be suitable candidates for early intervention by palliative care specialists. However, the average patient with CKD does not have an advanced care plan, has multiple debilitating symptoms, and does not utilise hospice care at the end of life. In this review, we outline the scope of the problem of unmet palliative care needs for patients with advanced CKD and ESRD, barriers to improving palliative care for patients with renal failure, and possible future directions for palliative nephrology. [...]it appears likely that patients with advanced renal disease and particularly ESRD would benefit from the incorporation of palliative care into their routine nephrology care. [...]we review future palliative nephrology system designs highlighted in recent literature to help meet the unmet needs of this patient population. There is no consensus definition of a hospice within Europe. [...]for the purposes of this review, the US hospice model is utilised, although the authors recognise that this constrains the review. [...]there is concern that a shortage of palliative care clinicians who already are primarily regionalised in larger metropolitan areas might prohibit patients from obtaining palliative care consultation.19 Improved care models of palliative nephrology delivery could remove one of the major disincentives to palliative care in patients with CKD. |
| Author | Sturgill, Daniel Bear, Alexandria |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30651241$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.2215/CJN.07510715 10.1001/jama.2012.476 10.1038/sj.ki.5000184 10.1177/0269216317720832 10.1001/jamainternmed.2018.0256 10.1053/j.ajkd.2016.08.035 10.1177/0269216313510342 10.1053/j.ajkd.2017.12.017 10.1161/CIRCHEARTFAILURE.115.002460 10.2215/CJN.03860609 10.1016/S0272-6386(03)00868-0 10.1111/nep.12586 10.1186/s12882-018-0894-5 10.1177/082585979100700202 10.2215/CJN.09740916 |
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| Copyright | 2019 © 2019 THE AUTHORS. Published by Elsevier Limited on behalf of the Royal College of Physicians. Royal College of Physicians 2019. All rights reserved. Copyright Royal College of Physicians Jan 2019 Royal College of Physicians 2019. All rights reserved. 2019 |
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| Keywords | ESRD palliative CKD care models |
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| References_xml | – volume: 16 start-page: 278 year: 2009 end-page: 289 ident: bib12 article-title: White Paper on standards and norms for hospice and palliative care in Europe: part 1 publication-title: Eur J Palliat Care contributor: fullname: Payne – volume: 12 start-page: 1001 year: 2017 end-page: 1009 ident: bib17 article-title: Time to improve informed consent for dialysis: an international perspective publication-title: Clin J Am Soc Nephrol contributor: fullname: Burgess – year: 2015 ident: bib20 publication-title: A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure contributor: fullname: Tonkin-Crine – volume: 19 start-page: 96 year: 2018 ident: bib2 article-title: Factors influencing dialysis withdrawal: a scoping review publication-title: BMC Nephrol contributor: fullname: Zhu – volume: 21 start-page: 241 year: 2016 end-page: 253 ident: bib10 article-title: Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: a systematic review and meta-analysis publication-title: Nephrology contributor: fullname: Gallagher – volume: 178 start-page: 792 year: 2018 end-page: 799 ident: bib13 article-title: Association between hospice length of stay, health care utilization, and medicare costs at the end of life among patients who received maintenance hemodialysis publication-title: JAMA Intern Med contributor: fullname: Keating – volume: 5 start-page: 72 year: 2010 end-page: 79 ident: bib6 article-title: Predicting six-month mortality for patients who are on maintenance hemodialysis publication-title: Clin J Am Soc Nephrol contributor: fullname: Germain – volume: 11 start-page: 633 year: 2016 end-page: 640 ident: bib9 article-title: Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis publication-title: Clin J Am Soc 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smart decisions about their care publication-title: JAMA doi: 10.1001/jama.2012.476 contributor: fullname: Cassel – volume: 69 start-page: 1621 year: 2006 ident: 10.7861/clinmedicine.19-1-26_bib14 article-title: Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: a simple assessment of symptom burden publication-title: Kidney Int doi: 10.1038/sj.ki.5000184 contributor: fullname: Davison – volume: 32 start-page: 395 year: 2017 ident: 10.7861/clinmedicine.19-1-26_bib7 article-title: External validation and clinical utility of a prediction model for 6-month mortality in patients undergoing hemodialysis for end-stage kidney disease publication-title: Palliat Med doi: 10.1177/0269216317720832 contributor: fullname: Forzley – volume: 178 start-page: 792 year: 2018 ident: 10.7861/clinmedicine.19-1-26_bib13 article-title: Association between hospice length of stay, health care utilization, and medicare costs at the end of life among patients who received maintenance hemodialysis publication-title: JAMA Intern Med doi: 10.1001/jamainternmed.2018.0256 contributor: fullname: Wachterman – volume: 69 start-page: 568 year: 2017 ident: 10.7861/clinmedicine.19-1-26_bib8 article-title: A clinical risk prediction tool for 6-month mortality after dialysis initiation among older adults publication-title: Am J Kidney Dis doi: 10.1053/j.ajkd.2016.08.035 contributor: fullname: Wick – volume: 28 start-page: 360 year: 2014 ident: 10.7861/clinmedicine.19-1-26_bib18 article-title: The development and piloting of the Renal specific Advanced Communication Training (REACT) programme to improve advance care planning for renal patients publication-title: Palliat Med doi: 10.1177/0269216313510342 contributor: fullname: Bristowe – volume: 55 start-page: 108 year: 2018 ident: 10.7861/clinmedicine.19-1-26_bib22 article-title: Building an outpatient kidney palliative care clinical program publication-title: JPSM contributor: fullname: Scherer – ident: 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nephrology: national survey results of nephrology fellows publication-title: Am J Kidney Dis doi: 10.1016/S0272-6386(03)00868-0 contributor: fullname: Holley – volume: 16 start-page: 278 year: 2009 ident: 10.7861/clinmedicine.19-1-26_bib12 article-title: White Paper on standards and norms for hospice and palliative care in Europe: part 1 publication-title: Eur J Palliat Care contributor: fullname: Radbruch – volume: 21 start-page: 241 year: 2016 ident: 10.7861/clinmedicine.19-1-26_bib10 article-title: Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: a systematic review and meta-analysis publication-title: Nephrology doi: 10.1111/nep.12586 contributor: fullname: Foote – volume: 19 start-page: 96 year: 2018 ident: 10.7861/clinmedicine.19-1-26_bib2 article-title: Factors influencing dialysis withdrawal: a scoping review publication-title: BMC Nephrol doi: 10.1186/s12882-018-0894-5 contributor: fullname: Qazi – year: 2015 ident: 10.7861/clinmedicine.19-1-26_bib20 publication-title: A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure contributor: fullname: Roderick – ident: 10.7861/clinmedicine.19-1-26_bib4 – volume: 7 start-page: 6 year: 1991 ident: 10.7861/clinmedicine.19-1-26_bib3 article-title: The Edmonton Symptom Assessment System (ESAS): a simple method of the assessment of palliative care patients publication-title: J Palliat Care doi: 10.1177/082585979100700202 contributor: fullname: Bruera – year: 2014 ident: 10.7861/clinmedicine.19-1-26_bib11 – volume: 12 start-page: 1001 year: 2017 ident: 10.7861/clinmedicine.19-1-26_bib17 article-title: Time to improve informed consent for dialysis: an international perspective publication-title: Clin J Am Soc Nephrol doi: 10.2215/CJN.09740916 contributor: fullname: Brennan – ident: 10.7861/clinmedicine.19-1-26_bib21 |
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| SubjectTerms | care models CKD ESRD Health Services Needs and Demand Hospice care Humans Kidney diseases Mortality palliative Palliative care Palliative Care - methods Renal Insufficiency, Chronic - therapy Review Systematic review |
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| Title | Unique palliative care needs of patients with advanced chronic kidney disease – the scope of the problem and several solutions |
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