scholarly journals Supportive care for end-stage kidney disease: an integral part of kidney services across a range of income settings around the world

2020 ◽  
Vol 10 (1) ◽  
pp. e86-e94 ◽  
Author(s):  
Barnaby Hole ◽  
Brenda Hemmelgarn ◽  
Edwina Brown ◽  
Mark Brown ◽  
Mignon I. McCulloch ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Supportive Care ◽  
End Stage Kidney Disease ◽  
The World ◽  
End Stage

scholarly journals P0205SYMPTOM BURDEN IN AUSTRALIAN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE AND END-STAGE KIDNEY DISEASE RECEIVING RENAL SUPPORTIVE CARE: A SINGLE CENTRE COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jenny Chen ◽  
Narelle Ilic ◽  
Holly Mitchell
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Supportive Care ◽  
Symptom Management ◽  
Symptom Improvement ◽  
End Stage Kidney Disease ◽  
Karnofsky Score ◽  
Advanced Chronic Kidney Disease ◽  
Asymptomatic Patients ◽  
End Stage

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.

scholarly journals Renal palliative and supportive care in South Africa – a consensus statement

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Nicola Wearne ◽  
Rene Krause ◽  
Bianca Davidson ◽  
Frank Brennan
Keyword(s):  
South Africa ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Healthcare Professionals ◽  
Consensus Statement ◽  
Communicable Diseases ◽  
End Stage Kidney Disease ◽  
High Burden ◽  
End Stage

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.

scholarly journals Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

2016 ◽  
Vol 11 (10) ◽  
pp. 1909-1914 ◽  
Author(s):  
Fliss E.M. Murtagh ◽  
Aine Burns ◽  
Olivier Moranne ◽  
Rachael L. Morton ◽  
Saraladevi Naicker
Keyword(s):  
Kidney Disease ◽  
Supportive Care ◽  
End Stage Kidney Disease ◽  
Conservative Care ◽  
End Stage

scholarly journals Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Hesham M. Elsayed ◽  
Shoyab Wadee ◽  
Mohamad S. Zaki ◽  
Anthony J. O. Were ◽  
Gloria E. Ashuntantang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Prevention Strategies ◽  
Limited Evidence ◽  
End Stage Kidney Disease ◽  
The World ◽  
Transplantation Rénale ◽  
Maladie Rénale Chronique ◽  
End Stage ◽  
Community Infection

Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed. L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires.

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