Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan

Objectives: Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. Method: We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. Results: Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43-8.70) or sepsis (OR 1.62, 95% CI 1.08–2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56–8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80–9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0–28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. Conclusion: Given the “Patient Right to Autonomy Act” implemented in Taiwan in 2019 to promote the concept of a “good quality of death”, this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.

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Kidney Transplant in an Old Woman-A Case Report and Review of the Literature

BANTAO Journal ◽

10.2478/bj-2014-0013 ◽

2015 ◽

Vol 12 (1) ◽

pp. 62-64

Author(s):

Lidija Orlic ◽

Ivana Mikolasevic ◽

Branka Sladoje-Martinovic ◽

Ivan Bubic and Sanjin Racki

Keyword(s):

Quality Of Life ◽

Renal Transplantation ◽

Elderly Patients ◽

End Stage Renal Disease ◽

Older Patients ◽

Review Of The Literature ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract The number of elderly patients with chronic kidney disease (CKD) as well as those with end-stage renal disease (ESRD) are increasing worldwide. Renal transplantation is now the treatment of choice for all ESRD patients, including those that are aged 65 or over. Namely, there is a growing evidence that elderly patients, in the absence of contraindications, have better outcomes after renal transplantation than alternative forms of RRT. Although survival, quality of life and economic advantages have been shown after transplantation, renal transplantation is still infrequently offered to older patients. Hereby, we present a case of an old woman who was transplanted in 1994 when “senior” program was still not established and when kidney transplantation at this age was rarity in many countries. She lived 16 years and 8 months with a well-functioning graft and died at the age of 89.

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Variation in end-stage renal disease patient outcomes: what we know, what should we know, and how do we find it out?

Journal of the American Society of Nephrology ◽

10.1681/asn.v3111738 ◽

1993 ◽

Vol 3 (11) ◽

pp. 1738-1747

Author(s):

P Kurtin ◽

A R Nissenson

Keyword(s):

Patient Outcomes ◽

Outcome Measure ◽

Disease Patient ◽

Patient Specific ◽

Quality Cost ◽

Current State ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

The size and expense of the ESRD program exceed all predictions made when the program was first initiated. Although the effectiveness of dialytic therapy is unquestioned, its value (quality/cost) is actively debated in this era of constricting resources. To better evaluate the quality of the ESRD program, it is essential to first define and quantitate the outcomes of dialytic care. Although mortality is a convenient outcome measure, it may be affected by many patient-specific as well as other factors that must be considered when evaluating and comparing new and existing technologies or advances. Quality of life is only beginning to be used in depth as an outcome measure, and much work is needed to standardize research methodology and thus move this area forward. The following review describes the current state of knowledge regarding outcomes of ESRD patients and proposes areas for future investigation, which should help increase the understanding of the value of the ESRD program to patients, providers, and payors.

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Health-Related Quality of Life in End-Stage Renal Disease Patients: How Often Should We Ask and What Do We Do with the Answer?

Blood Purification ◽

10.1159/000441462 ◽

2016 ◽

Vol 41 (1-3) ◽

pp. 218-224 ◽

Cited By ~ 16

Author(s):

Shan Shan Chen ◽

Saleem Al Mawed ◽

Mark Unruh

Keyword(s):

Quality Of Life ◽

Patient Reported Outcomes ◽

Dialysis Patients ◽

Patient Reported ◽

Related Quality ◽

Health Related ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background: End-stage renal disease (ESRD) patients have poor health-related quality of life (HRQOL) comparing to general population and comparable HRQOL to patients with other major chronic diseases. Poor HRQOL is associated with shorter survival. There is a limited threshold to which dialysis dose and parameters management can improve HRQOL in ESRD patients. Numerous studies have sought to find interventions to improve HRQOL. This article is to review the symptoms associated with poor HRQOL and how frequent the quality of life (QOL) should be evaluated to improve the outcome. Summary: It is required by the Center for Medicare and Medicaid Services to evaluate HRQOL of dialysis patients annually. KDIGO recommends the symptoms to be assessed regularly and the treatment is redirected toward a patient-centered care model. Studies have shown that measuring patient-reported outcomes frequently, from 4 times a day to every 3-6 months, without intervention did not improve the HRQOL significantly. Appropriate intervention of the symptoms may improve the quality of life (QOL). Studies in oncology have also showed a similar result. The commonly used tools to evaluate the HRQOL in dialysis patients take up to 30 min for completion. Therefore, frequent assessment of all the symptoms can provide more burden than benefit to the patients. In addition to the annual HRQOL measurements, more frequent evaluation of targeted symptoms can be helpful. For appropriate intervention of the symptoms, effective communication between providers, as well as a multidisciplinary approach, is essential to improve HRQOL and outcomes in dialysis patients. Key Messages: Measurement of patient-reported outcomes may provide an opportunity to improve outcomes in ESRD. The frequent measurement of symptoms and QOL may be burdensome. Consider targeted measurement of symptoms to complement HRQOL measurement. Improved communication and the use of a multidisciplinary team provide mechanisms to improve HRQOL in ESRD.

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Quality of Life and Depression in Patients With End-stage Renal Disease: a Comparison of Renal Replacement Therapy Modalities

10.21203/rs.3.rs-189187/v1 ◽

2021 ◽

Author(s):

Fei Yang ◽

Zheng Yang ◽

Lu Cheng ◽

Jiayu Tong ◽

Pusheng Wang

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Renal Replacement Therapy ◽

End Stage Renal Disease ◽

Sf 36 ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients ◽

Component Scores

Abstract Purpose. Patients with end-stage renal disease (ESRD) face various physical and mental limitations resulting from different renal replacement therapy (RRT) modalities. Renal transplantation (Tx) is considered as the treatment that impacts most on health-related quality of life (HRQOL). This study aimed to analyze and compare the HRQOL and depression levels of patients undergoing hemodialysis (HD), peritoneal dialysis (PD) and Tx.Methods. A single-center cross-sectional sample of 112 HD patients, 68 PD patients and 97 Tx patients participated in our questionnaire survey. The HRQOL and depression levels were assessed through the 36-Item Short-Form Health Survey (SF-36) and Mental Health Inventory (MHI-5), respectively. The multiple linear regression model was performed to examine the factors associated with each of the HRQOL scale scores. Results. The SF-36 HRQOL of Tx patients differed significantly from that in HD and PD groups in all eight dimensions and two components (all P<0.001). More than 45% of patients in each group were facing depressive symptoms. HD patients (63.4%) and PD (67.6%) patients were more depressive compared with Tx patients (45.4%, P =0.006). Depression in ESRD patients contributed to a worse quality of life (P<0.001). Patients ranging in age from 31 to 50, having full-time jobs, receiving Tx and without depression were associated with better HRQOL in the domain of Physical Component Scores (PCS). Patients with unemployment, dismissal or being looking for a job, receiving Tx and without depression were associated with better HRQOL in the domain of Mental Component Scores (MCS).Conclusions. Tx patients had better HRQOL and less depressive symptoms than HD and PD patients. Depression was related to an impaired HRQOL, which was common in ESRD patients. The severity of depression in ESRD patients and the effectiveness of Tx on HRQOL improvement need to be underscored.

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Determination of the Optimal Procalcitonin Threshold for Infection in Patients With Impaired Renal Function at a Community Hospital

Journal of Pharmacy Technology ◽

10.1177/8755122520924803 ◽

2020 ◽

Vol 36 (4) ◽

pp. 157-163

Author(s):

Caitlin Bowman ◽

Elizabeth W. Covington

Keyword(s):

Renal Dysfunction ◽

Bacterial Infections ◽

Operating Characteristic ◽

Characteristic Curve ◽

Kidney Injury ◽

Future Studies ◽

Institutional Review ◽

Stage Renal Disease ◽

End Stage

Background: Procalcitonin (PCT) is a biomarker that can help identify bacterial infections but can be difficult to interpret in the presence of renal dysfunction, which can elevate PCT even in the absence of infection. Objective: To determine the optimal PCT threshold to identify infection in patients with renal dysfunction and pneumonia or sepsis. Methods: A retrospective analysis was performed for inpatients with creatinine clearance of ≤60 mL/min and PCT level from 2018 to 2019. A pharmacist blinded to study outcomes classified patients as infected or noninfected based on predetermined criteria. Receiver operating characteristic curve analysis was performed to establish the optimal PCT threshold overall, as well as in subgroups of patients with chronic kidney disease (CKD), acute kidney injury (AKI), and end-stage renal disease (ESRD). Institutional review board approval was obtained. Results: A total of 198 patients were included in the study (99 infected, 99 noninfected). The optimal threshold in the AKI, CKD, and ESRD subgroups was determined to be 1.5 ng/mL, 0.1 ng/mL, and 1.75 ng/mL, respectively. Conclusion: The results of this study show that PCT thresholds were specific to type of renal dysfunction. These results differ from the traditionally accepted PCT threshold of 0.5 ng/mL for sepsis and 0.25 mg/mL for pneumonia. Future studies should confirm the appropriate PCT threshold in ESRD and CKD patient populations.

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Rehabilitating a Dialysis Patient

Peritoneal Dialysis International ◽

10.1177/089686080302302s17 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 81-83 ◽

Cited By ~ 3

Author(s):

Yuk-Yee Cheng ◽

Ying-Fan Wong ◽

Bonnie Y.C. Chu ◽

Woon-Or Lam ◽

Yiu-Wing Ho

Keyword(s):

Rehabilitation Program ◽

Social Psychological ◽

Dialysis Unit ◽

Patient Support Group ◽

Group A ◽

Stage Renal Disease ◽

End Stage ◽

Renal Patient ◽

Esrd Patients

End-stage renal disease (ESRD) patients undergoing dialysis face much stress and have to make adjustments in their lives. To optimize health and improve quality of life, rehabilitation of renal patients is a necessity. Renal rehabilitation includes physical, social, psychological, and vocational elements. We established a renal rehabilitation program—including predialysis education, in-center training, and community rehabilitation—in our regional dialysis unit. The program is organized by a multidisciplinary team of health professionals with the help of a renal-patient support group. A patient who joined the rehabilitation program showed significant lifestyle change.

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Lived Experience of Patients Undergoing Hemodialysis: Quality of Life Perspective

International Journal of Indian Psychology ◽

10.25215/0302.169 ◽

2016 ◽

Vol 3 (2) ◽

Author(s):

Mrs. Rohini. T ◽

Dr. Punitha. V. Ezhilarasu

Keyword(s):

Quality Of Life ◽

Lived Experience ◽

Structured Interviews ◽

Van Manen ◽

Related Quality ◽

Health Related ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

There is growing recognition of Health-Related Quality of Life (HRQOL) issues in End Stage Renal Disease (ESRD) patients undergoing Hemodialysis (HD). The aim of the present study was to explore the lived experience of Quality of Life (QOL) among patients undergoing Hemodialysis. The study involved a qualitative approach that used an interpretive hermeneutic phenomenology based on Van Manen’s method. The sample included seven patients undergoing Hemodialysis in two selected hospitals at Ernakulam district in Kerala. They were recruited by purposive sampling. Data were collected using semi-structured interviews. The thematic analysis followed the six steps delineated by Max Van Manen and four themes emerged. They were crestfallen life (3 sub themes; hard pressed life, deserted life and abounding losses); support and comfort; accompanying death and unfulfilled wishes. The findings shed light on the lived experience of QOL that has not yet been researched in an Indian scenario. The generated knowledge can be used by health professionals including nurses to help patients undergoing HD lead a life with better quality of life.

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Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study

Medicine and Pharmacy Reports ◽

10.15386/mpr-1320 ◽

2019 ◽

Author(s):

Rositsa Dimova ◽

Donka Keskinova ◽

Valeri Tzekov ◽

Gergana Ginova-Noncheva

Keyword(s):

Quality Of Life ◽

Health Related Quality ◽

Life Index ◽

Related Quality ◽

Health Related ◽

Quality Of Life Index ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background and aims. Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument. Methods. Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient. Results. The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied than women when fulfilling their daily activities (Р=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (Р=0.043). Conclusions. B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as “Fair“. Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

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Comparison of CHA2DS2-VASc and C2HEST scores for predicting the incidence of atrial fibrillation among patients with end-stage renal disease

Perfusion ◽

10.1177/0267659120930931 ◽

2020 ◽

Vol 35 (8) ◽

pp. 842-846

Author(s):

Wei-Syun Hu ◽

Cheng-Li Lin

Keyword(s):

Atrial Fibrillation ◽

Renal Disease ◽

End Stage Renal Disease ◽

Predictive Power ◽

Operating Characteristic ◽

Characteristic Curve ◽

Predictive Capability ◽

Stage Renal Disease ◽

End Stage ◽

Insurance Database

Purpose: The authors have studied assessment of CHA2DS2-VASc score versus C2HEST score in atrial fibrillation risk prediction in end-stage renal disease patients. Methods: The authors conducted this study by Longitudinal Health Insurance Database 2000. The authors totally enrolled 4,601 end-stage renal disease patients. The predictive capability of atrial fibrillation by using CHA2DS2-VASc and C2HEST score was estimated by area under the receiver operating characteristic curve (AUROC). Results: The AUROC for CHA2DS2-VASc score in predicting atrial fibrillation events was 0.5786, and AUROC for C2HEST score for atrial fibrillation prediction was 0.5983. Conclusion: Both scores yield almost identical AUROC values implying no difference in predictive power. Further work is warranted to verify the prognostic value of the current scores.

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P1542DIALYSIS MODALITY AND OUTCOMES IN GERIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS. AN ASIAN SINGLE CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1542 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jeevita Supayah ◽

Hin Seng Wong ◽

Fei Yee Lee ◽

Suryati Yakob

Keyword(s):

Dialysis Initiation ◽

Dialysis Modality ◽

Single Center Experience ◽

Co Morbidity ◽

The Mean ◽

Maintenance Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background and Aims The prevalence of CKD increases with age and more elderly patients are on maintenance dialysis as advanced age is no longer an impediment. The selection of dialysis modality can be difficult for the simultaneous benefit and burden of individual modality on top of the complexity of co-morbidity and quality of life. To study the survival outcomes based on dialysis modality in geriatric ESRD patients Method The cohort of geriatric patients (aged > 65 years) with ESRD who were referred to our pre-dialysis clinic from 1st January 2016 to 31st December 2018 and started on maintenance dialysis were identified via the hospital information system. Demographics, co-morbidities, dialysis modalities and clinical outcome in terms of survival were obtained from the hospital electronic medical record. Glomerular filtration rates (eGFR) were calculated using the CKD-EPI formula in mls/min/1.73m2. The statistical analysis was done using SPSS version 23. Results A total of 145 geriatric ESRD patients were initiated on chronic dialysis. The cohort was predominated by male with 77 patients (53.1%). The mean age was 72.5±5.2 years. Majority had multiple comorbidities with 95% having hypertension, 82.8% with diabetes, 65.5% and 32.8% having dyslipidemia and ischemic heart disease, respectively. The mean eGFR at point of referral and dialysis initiation were 12.5±4.9 mls/min/1.73m2 and 6.57±2.33 mls/min/1.73m2 respectively. Mean duration to initiate dialysis from first review was 6.7±5.8 months. Majority opted for hemodialysis (HD) with 106 patients (73.1%). 74% patients in the HD cohort initiated dialysis via a catheter and remainder with an arteriovenous fistula (AVF). 39 patients (27.1%) opted for peritoneal dialysis (PD) and all were initiated via tenckhoff catheter. Mean eGFR at dialysis initiation were 6.44±2.47 (HD) and 6.9±1.9(PD) respectively. At 6 months, all PD patients survived and 18.2% of HD patients died with statistically significance difference at p=0.003. No survival predictors were identified. Conclusion PD modality has advantage in survival outcome in geriatric ESRD patients.

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