End Stage Kidney Disease Patient Experiences of Renal Supportive Care in an Australian Teaching Hospital - A qualitative study

Author(s):  
Ms Eloise Sobels ◽  
Megan Best ◽  
Steve Chadban ◽  
Dr Riona Pais
2020 ◽  
Vol 10 (1) ◽  
pp. e86-e94 ◽  
Author(s):  
Barnaby Hole ◽  
Brenda Hemmelgarn ◽  
Edwina Brown ◽  
Mark Brown ◽  
Mignon I. McCulloch ◽  
...  

2020 ◽  
Vol 41 (45) ◽  
pp. 4361-4361
Author(s):  
Saarwaani Vallabhajosyula ◽  
Sameh M Said ◽  
Anna S Kitzmann ◽  
Hector I Michelena

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jenny Chen ◽  
Narelle Ilic ◽  
Holly Mitchell

Abstract Background and Aims Renal supportive care (RSC) is a novel multidisciplinary patient-centred model of care that focuses on symptom management and quality of life improvement in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD), including conservative care. Despite an increased interest in embedding RSC into routine nephrology practice, there is limited literature on the effects of symptom improvement in patients attending RSC services. We aimed to examine symptom improvement and symptom progression in patients receiving renal supportive care. Method Using Integrated Palliative care Outcome Scale Renal (IPOS-renal) scores collected during routine RSC clinics, we analysed the changes in individual IPOS-renal items and summative scores for symptoms associated with chronic kidney disease, stratified by time from the initial clinic visit (0-6 months, 6-12 months, and >12 months), in all patients attending our RSC service in a tertiary hospital between November 2015 and July 2019. Results Of 245 patients referred to our RSC service, 61 patients completed two or more IPOS-renal surveys. At initial visit, majority of the patients were reviewed at hospital outpatient clinic (n=42, 71%), followed by dialysis (n=8, 13%), home visit (n=6, 10%), and inpatient ward (n=4, 7%). The median (IQR) eGFR was 13 (7-16) ml/min/1.73m2 and median Karnofsky score was 70 (60-80). Weakness (n=59, 97%) and poor mobility (n=52, 85%) were the most common initial complaints. For all reported symptoms, dyspnea improved the most for all three time periods (summative IPOS score changes of 28, 17, and 8 points for 0-6, 6-12, >12 months, respectively). Poor mobility was the only symptom that continued to deteriorate between 0-6 months despite attending renal supportive care (without a physiotherapist). For asymptomatic patients, more than half of the symptoms remained quiescent after attending RSC service for more than 12 months. Among newly developed symptoms, nausea, dyspnea, and drowsiness were most common between 0-6 months. In contrast, pruritus, dry mouth, and constipation were the most common complaints after 12 months. Conclusion RSC interventions provided symptom improvement in patients with advanced CKD and ESKD, but poor mobility remained a concern in this population. Incorporating physiotherapy to RSC may further improve symptom management.


2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Nicola Wearne ◽  
Rene Krause ◽  
Bianca Davidson ◽  
Frank Brennan

In South Africa, there is a high burden of end-stage kidney disease (ESKD). This is due to the burgeoning epidemics of communicable diseases like HIV/AIDS and non-communicable diseases, particularly hypertension and diabetes mellitus. One of the most difficult situations encountered by healthcare professionals dealing with patients with ESKD in South Africa is the management of a conservative or palliative care pathway for the many patients who have no other option. Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Many patients are managed in primary healthcare settings and either do not have access to palliative care or are not referred appropriately. Renal supportive and palliative care involves a multidisciplinary approach to managing patients with ESKD, to ensure that symptoms are managed optimally and to provide support during advanced disease. It aims to improve quality of life for patients and their families and must be provided alongside curative medical care. This support should include those unable to gain access to life-saving dialysis and it should also provide care for patients where dialysis is not the best option. The aim of this consensus statement is to assist healthcare providers to improve the management of symptoms and biosocial factors of patients with end-stage kidney disease in a South African context. The document was compiled through consensus building among healthcare professionals across South Africa. The professionals that are represented included nephrologists, palliative care physicians, social workers, nurses, paediatricians and hospital managers. We wish to acknowledge the contribution of Dr Frank Brennan, a leading expert in renal palliative and supportive care, who assisted greatly in the compilation of this document.


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