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 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.

Primary Palliative Care Education for the Multidisciplinary Nephrology Team

2020 ◽  
pp. 58-66
Author(s):  
J. Pedro Teixeira ◽  
Sara A. Combs
Keyword(s):  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Multidisciplinary Team ◽  
Care Program ◽  
Team Members ◽  
Knowledge And Skills ◽  
Palliative Care Education ◽  
End Stage

Supportive care of patients with progressive kidney failure, like the care needed by all patients with chronic kidney disease and end-stage kidney disease, is most successfully provided through a multidisciplinary team. An effective kidney supportive care program requires that the multidisciplinary team be properly educated on the palliative needs of these patients and that team members develop primary palliative care skills to meet these needs. This chapter presents the case for why nephrology clinicians need to acquire primary palliative care knowledge and skills to better treat their patients. It reviews the existing state of supportive care for patients with kidney disease and of the training in primary palliative care currently provided to nephrology fellows and nephrologists. It recommends the development of a primary palliative care curriculum for members of the multidisciplinary kidney care team involved in patient care and makes suggestions on curriculum content for nephrology clinicians.

scholarly journals End-stage kidney disease and rationing of kidney replacement therapy in the free state province, South Africa: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thabang T Molaoa ◽  
Feziwe B Bisiwe ◽  
Kwazi CZ Ndlovu
Keyword(s):  
Diabetes Mellitus ◽  
South Africa ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Organ Dysfunction ◽  
Free State ◽  
End Stage Kidney Disease ◽  
Rationing Policy ◽  
Kidney Replacement Therapy ◽  
End Stage

Abstract Background End-stage kidney disease (ESKD) and the required kidney replacement therapy (KRT) are significant public health challenges for low-and-middle-income countries. The South African government adopted a KRT rationing policy to balance the growing need for KRT and scarce resources. We aimed to describe the epidemiology and KRT access in patients with ESKD referred to the main public sector hospital in the Free State Province, South Africa. Methods A retrospective study of adult patients with ESKD admitted to Universitas Academic Hospital for KRT, was conducted between 1 January 2016 and 31 December 2018. A review of the KRT committee decisions to offer or deny KRT based on the KRT rationing policy of the Free State was undertaken. Demographic information, KRT committee outcomes, laboratory test results, and clinical details were collected from assessment tools, KRT committee meeting diaries, and electronic hospital records. Results Of 363 patients with ESKD referred for KRT access, 96 with incomplete records were excluded and 267 were included in the analysis. Median patient age was 40 (interquartile range, 33‒49) years, and male patients accounted for 56.2 % (150/267, p = 0.004) of the cohort. The average annual ESKD incidence was 49.9 (95 % confidence interval [CI], 35.8‒64.0) per-million-population. The most prevalent comorbidities were hypertension (42.3 %; 113/267), human immunodeficiency virus (HIV) (28.5 %; 76/267), and diabetes mellitus (19.1 %; 51/267). The KRT access rate was 30.7 % (82/267), with annual KRT incidence rates of 8.05 (95 % CI, 4.98‒11.1), 11.5 (95 % CI, 7.83‒15.1), and 14.1 (95 % CI, 10.3‒18.0) per-million-population in 2016, 2017, and 2018, respectively. Advanced organ dysfunction was the commonest reason recorded for KRT access denial (58.9 %; 109/185). Age (odds ratio [OR], 1.04; 95 % CI, 1.00‒1.07; p = 0.024) and diabetes (OR, 5.04; CI, 1.69‒15.03; p = 0.004) were independent predictors for exclusion from KRT, while hypertension (OR, 1.80; 1.06‒3.04; p = 0.029) independently predicted advanced organ dysfunction resulting in KRT exclusion. Conclusions Non-communicable and communicable diseases, including hypertension, diabetes, and HIV, contributed to ESKD, highlighting the need for improved early prevention strategies to address a growing incidence rate. Two-thirds of ESKD patients were unable to access KRT, with age, diabetes mellitus, and advanced organ dysfunction being significant factors adversely affecting KRT access.

Sign in / Sign up

Export Citation Format

Share Document