End stage disease treatment options

AbstractOsteoarthritis (OA) is the most common joint disease worldwide, leading to significant pain, restricted range of motion, and disability. A gap exists between short- and long-term symptom-relieving therapies. Although arthroplasty is an effective treatment for symptomatic end-stage disease, most patients ultimately do not receive a joint replacement due to suboptimal surgical qualifications, comorbidities, or an aversion to surgery. The lack of additional treatment options in this setting makes opioid agonists a commonly used pharmacologic agent, contributing to the addiction epidemic that greatly afflicts our communities. Cooled radiofrequency ablation (CRFA) has arisen as a treatment modality in the setting of moderate to severe OA among patients refractory to conservative management, generally showing greater efficacy compared with other existing strategies. This review focuses on the benefits of CRFA and its technical feasibility as a management option among patients experiencing debilitating large joint OA with limited clinical options.

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“I Wish Someone Had Told Me That Could Happen”: A Thematic Analysis of Patients’ Unexpected Experiences With End-Stage Kidney Disease Treatment

Journal of Patient Experience ◽

10.1177/2374373519872088 ◽

2019 ◽

Vol 7 (4) ◽

pp. 577-586

Author(s):

Nicole DePasquale ◽

Ashley Cabacungan ◽

Patti L Ephraim ◽

LaPricia Lewis-Boyér ◽

Clarissa J Diamantidis ◽

...

Keyword(s):

Kidney Disease ◽

Treatment Options ◽

Clinical Aspects ◽

End Stage Kidney Disease ◽

Disease Treatment ◽

Psychological Reactions ◽

Treatment Delivery ◽

Treatment Groups ◽

End Stage ◽

Treatment Education

Background: Preparedness regarding prognosis and treatment options enables patients to cope with uncertainties, make value-based treatment decisions, and set treatment goals. Yet, little is known about the expectedness of end-stage kidney disease (ESKD) patients’ treatment experiences beyond their desire for better treatment education. Objective: To describe unexpected adverse treatment experiences among ESKD patients. Method: The authors conducted 7 focus groups with 55 dialysis patients and living-donor kidney transplantation recipients receiving medical care in Baltimore, Maryland. Data were analyzed thematically. Themes present in different treatment groups were highlighted to provide insight into common experiences. Results: The authors identified 5 themes: (1) psychological reactions, (2) constrained freedom of choice, (3) treatment delivery and logistics, (4) morbidity, and (5) finances. Conclusion: Patients were unprepared for nonclinical, logistical, and clinical aspects of ESKD treatment. The need for providers’ use of tailored preparatory techniques and the development of pretreatment interventions to help patients know what to expect from and feel psychologically prepared for treatment, particularly with respect to nonclinical implications, is critical. These efforts have great potential to improve patients’ treatment experiences.

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Cystic Fibrosis: Emerging Understanding and Therapies

Annual Review of Medicine ◽

10.1146/annurev-med-112717-094536 ◽

2019 ◽

Vol 70 (1) ◽

pp. 197-210 ◽

Cited By ~ 20

Author(s):

Michael M. Rey ◽

Michael P. Bonk ◽

Denis Hadjiliadis

Keyword(s):

Cystic Fibrosis ◽

Treatment Options ◽

Specific Treatment ◽

Patient Specific ◽

Common Life ◽

Improved Outcomes ◽

Stage Disease ◽

Increased Risk ◽

Caucasian Patients ◽

End Stage

Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasian patients. Continued advances have led to improved survival, and adults with CF now outnumber children. As our understanding of the disease improves, new therapies have emerged that improve the basic defect, enabling patient-specific treatment and improved outcomes. However, recurrent exacerbations continue to lead to morbidity and mortality, and new pathogens have been identified that may lead to worse outcomes. In addition, new complications, such as CF-related diabetes and increased risk of gastrointestinal cancers, are creating new challenges in management. For patients with end-stage disease, lung transplantation has remained one of the few treatment options, but challenges in identifying the most appropriate patients remain.

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Ex vivo Approach to Treat Failing Organs: Expanding the Limits

European Surgical Research ◽

10.1159/000367942 ◽

2014 ◽

Vol 54 (1-2) ◽

pp. 64-74 ◽

Cited By ~ 6

Author(s):

Anatol Ciubotaru ◽

Axel Haverich

Keyword(s):

Medical Treatment ◽

Life Support ◽

Ex Vivo ◽

Treatment Options ◽

Diagnostic Methods ◽

Organ Shortage ◽

Organ Perfusion ◽

Stage Disease ◽

Number Of Patients ◽

End Stage

Background: Advanced organ failure is often classified as an end-stage disease where the treatment options are limited only to transplantation. As an alternative, different attempts have been undertaken to improve the outcome of the treatment of failing organs by using targeted ex vivo approaches. This may solve the issue of organ shortage by treating the donor organs before transplantation and the number of patients requiring transplantation may also be reduced by applying extensive ex vivo treatment followed by autotransplantation. Methods: We performed a literature review of PubMed and included articles published between 1962 and 2013. The following keywords were used (and; or): ex vivo, therapy, surgery, organ perfusion and autotransplantation. This review includes specific methods and attempts related to ex vivo organ perfusion and preservation, temporary life support systems, surgical and other therapeutic approaches, and diagnostic methods applied ex vivo to an isolated organ. Results: For the practical clinical use of ex vivo therapies, we could identify three major directions: (1) ex vivo pretransplant organ reconditioning, (2) ex vivo surgery and (3) ex vivo medical treatment. Different attempts have been made worldwide in the above-mentioned areas focusing on ex vivo organ preservation and treatment. We summarize in the present review the developments in the field of ex vivo organ recovery and evaluate the possibilities of combining and applying different technologies such as organ perfusion and storage, ex vivo exact topographical diagnosis, ex vivo locoregional medical treatment and ex vivo surgical correction. Conclusion: Ex vivo therapies open new horizons in the treatment of end-stage organ pathologies.

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End-stage renal disease treatment options education: What matters most to patients and families

Seminars in Dialysis ◽

10.1111/sdi.12665 ◽

2018 ◽

Vol 31 (2) ◽

pp. 122-128 ◽

Cited By ~ 4

Author(s):

Jennifer St. Clair Russell ◽

L. Ebony Boulware

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Treatment Options ◽

Disease Treatment ◽

Stage Renal Disease ◽

End Stage ◽

What Matters

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Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters

Current Drug Therapy ◽

10.2174/1574885514666190802144629 ◽

2020 ◽

Vol 15 (3) ◽

pp. 249-263

Author(s):

Maria Aktsiali ◽

Theodora Papachrysanthou ◽

Ioannis Griveas ◽

Christos Andriopoulos ◽

Panagiotis Sitaras ◽

...

Keyword(s):

Bone Mineral ◽

Mineral Metabolism ◽

Treatment Options ◽

Dry Weight ◽

Chronic Hemodialysis ◽

Protective Agent ◽

Positive Correlation ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background: Due to the premium rate of Chronic Kidney Disease, we have increased our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End- Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and Parathormone levels, improving the quality of life. The aim of the present study was to investigate the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia parameters such as hematocrit and hemoglobin. Materials and Methods: retrospective observational study was conducted in a Chronic Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of 30-120 mg. Results: Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet. Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested. Conclusions: Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved for use in ESRD patients to assist SHPT. A novel information was obtained from this study, regarding the improvement of the control of anemia.

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Case of thymic parathyroid carcinoma in a haemodialysis patient: application of tumour chemosensitivity testing

The Journal of Laryngology & Otology ◽

10.1258/002221504772784685 ◽

2004 ◽

Vol 118 (2) ◽

pp. 162-164 ◽

Cited By ~ 6

Author(s):

I. A. Srouji ◽

A. Resouly ◽

I. A. Cree

Keyword(s):

End Stage Renal Disease ◽

Parathyroid Carcinoma ◽

Haemodialysis Patient ◽

Treatment Options ◽

Rare Tumour ◽

Tertiary Hyperparathyroidism ◽

Stage Renal Disease ◽

End Stage ◽

Individual Tumour ◽

Non Surgical Treatment

Parathyroid carcinoma is a rare tumour, which is often difficult to diagnose. This is especially true in patients with pre-existing tertiary hyperparathyroidism of end-stage renal disease. A case is presented of parathyroid carcinoma in a haemodialysis patient withunusual thymic involvement. After demonstrating the difficulty in pre-operative diagnosis and risk of recurrence, the importance of non-surgical treatment options is discussed and the investigation of individual tumour chemosensitivity is introduced, which is new to this type of cancer.

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