Ethical Challenges and the Role of Palliative Care in Kidney Disease

2019 ◽  
pp. 297-309.e2
Author(s):  
Michael J. Germain ◽  
Lewis M. Cohen
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Ethical Challenges

Involving Family and Friends in Palliative Care for Persons With Kidney Disease

2020 ◽  
pp. 108-115
Author(s):  
Elizabeth Anderson ◽  
David M. White
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
End Of Life ◽  
Family Caregivers ◽  
Great Promise ◽  
Cultural Norms ◽  
Centered Care ◽  
Family Beliefs ◽  
Family Centered

Family-centered palliative care for patients with kidney disease shows great promise in alleviating the suffering of patients with collateral benefits to family members. Engaging family caregivers is particularly valuable for those with kidney disease, given often multiple comorbidities, impact of dialysis on quality of life, and often conflicting end-of-life decisions. Family caregivers are at high risk for burnout, increasing the likelihood that patients themselves will not receive end-of-life care or support. Important components of family-centered palliative care include assessment, emotional support, education, assertive communication skills, referrals, and grief and bereavement support. It is crucial that the care team recognize the role of cultural norms, family beliefs, and communication patterns, tailoring family-centered care to meet the needs of each individual patient.

Potential effect of pharmaceutical care to improve outcomes in patients with chronic kidney disease-mineral bone disorder in Sulaimani dialysis centers

2020 ◽  
pp. 82-94
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pharmaceutical Care ◽  
Biochemical Parameters ◽  
Positive Impact ◽  
Potential Effect ◽  
Care Group ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Objective: the present study was aimed to evaluate the role of pharmaceutical services in improving the outcome of mineral bone disorder in patients with advanced chronic kidney disease. Methodology: One hundred and twenty patients with chronic kidney disease-mineral bone disorder (CKD-MBD) screened for eligibility, seventy-six patients enrolled in the study and randomly allocated into two groups: pharmaceutical care and usual care, both groups interviewed by the pharmacist using specific questionnaire for assessing the quality of life (QoL). All the drug related problems (DRPs) including drug-drug interactions (DDIs) were recorded by the pharmacist. Blood samples were collected and utilized for analyzing the levels of vitamin D, phosphorous, calcium, albumin and parathyroid hormone at baseline and three months after. The pharmaceutical care group received all the educations about their medications and how to minimize DRPs; improve the QoL. Additionally, the pharmaceutical intervention included correcting the biochemical parameters. Results: Pharmaceutical care significantly improved patients QoL and minimized DRPs and DDIs. It was also effective in improving the biochemical parameters. Conclusion: Pharmaceutical care has a positive impact on improving the outcome of patients with CKD-MBD through attenuating DRPs, improving the biochemical parameters and the QoL.

MOLECULAR ASPECTS OF SARCOPENIA PATHOGENESIS IN CHRONOC KIDNEY DISEASE: INTEGRATED ROLE OF mTOR

2018 ◽  
Vol 22 (5) ◽  
pp. 9-16 ◽  
Author(s):  
M. Z. Gasanov
Keyword(s):  
Kidney Disease ◽  
Muscle Mass ◽  
Protein Metabolism ◽  
Mammalian Target Of Rapamycin ◽  
Healthy Person ◽  
Scientific Review ◽  
Cytoskeleton Organization ◽  
Molecular Aspects ◽  
End Stage

In recent decades, the main pathogenetic mechanisms for maintaining muscle mass and strength have been discovered. Most of the scientific papers on the molecular aspects of the  pathogenesis of sarcopenia were focused on the Akt-signaling  pathway. The subject of the study were people of elderly and senile  age, immobilized patients, patients with CKD 1-4 stages, animals. However, recently more attention has been paid to the role  of protein – the mammalian target of rapamycin mTOR. It seems to be a key link in the control of muscle mass and is a promising  marker in understanding the mechanisms of the pathogenesis of  sarcopenia. Its importance in protein metabolism in patients with  end stage kidney disease is not studied and requires further research. The presented scientific review contains  information on the role of mTOR and its components – mTORC1 and mTORC2 in maintaining muscle mass and strength in a healthy  person and in the formation of sarcopenia in patients with CKD. The  general aid of mTORC1 complex is regulation of protein production  which is necessary for cell growth and differentiation. mTORC2  complex functions are not enough studied. It is established that it  plays important role in such biological processes as cytoskeleton  organization, intracellular homeostasis maintaining, so it provides  cell resistance and cell survivability in negative external and internal  impulses. mTOR protein can be considered as promising molecular  marker in diagnostics of protein metabolism early disturbances in  patients with CKD and also as additory factor of sarcopenia severity assessment.

The role of nutritional support in the provision of palliative care

2020 ◽  
pp. 55-64
Author(s):  
N. Zarechnov ◽  
A. Kuznetsov ◽  
N. Seliverstova
Keyword(s):  
Palliative Care ◽  
Nutritional Support

The article is devoted to the problem of nutrition of patients receiving palliative care. The authors emphasize the importance of nutritional support for this group of patients and describe the experience of enteral and paraenteral nutrition.

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