Aging and ESRD Demographics: Consequences for the Practice of Dialysis

Williams, Mark E.; Sandeep, Jeena; Catic, Angela G.

doi:10.1111/sdi.12029

Cited by 14 publications

(12 citation statements)

References 32 publications

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“…Individuals with ESRD on dialysis, currently numbering over 400,000 in the United States, face significant morbidity and mortality (1). Mortality in the first year on dialysis for patients over 75 years old approaches 40% (2), and even those with better prognoses face multiple hospitalizations and declining functional status (3)(4)(5). Long-term outcomes from aggressive treatment, such as cardiopulmonary resuscitation, are poor in patients on dialysis (6), and recent data also suggest that, for individuals over age 80 years old, dialysis may offer little to no benefit over conservative management (7,8).…”

Section: Introductionmentioning

confidence: 99%

Serious Illness Conversations in ESRD

Mandel

Bernacki

Block

2016

CJASN

118

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Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less. This high intensity of care is often inconsistent with the wishes of patients on dialysis but persists due to failure to explore or discuss patient goals, values, and preferences in the context of their serious illness. Fewer than 10% of patients on dialysis report having had a conversation about goals, values, and preferences with their nephrologist, although nearly 90% report wanting this conversation. Many nephrologists shy away from these conversations, because they do not wish to upset their patients, feel that there is too much uncertainty in their ability to predict prognosis, are insecure in their skills at broaching the topic, or have difficulty incorporating the conversations into their clinical workflow. In multiple studies, timely discussions about serious illness care goals, however, have been associated with enhanced goal-consistent care, improved quality of life, and positive family outcomes without an increase in patient distress or anxiety. In this special feature article, we will () identify the barriers to serious illness conversations in the dialysis population, () review best practices in and specific approaches to conducting serious illness conversations, and () offer solutions to overcome barriers as well as practical advice, including specific language and tools, to implement serious illness conversations in the dialysis population.

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Section: Introductionmentioning

confidence: 99%

Serious Illness Conversations in ESRD

Mandel

Bernacki

Block

2016

CJASN

118

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“…Second, there is increasing prevalence of other chronic diseases in westernised societies, such as hypertension, diabetes and obesity1 4 5 which are associated with the development of CKD. Last, although specific data is sparse, there is a general acceptance of more relaxed criteria for considering a patient for dialysis 6. The result of these changes is that nephrologists are now responsible for an older patient cohort for whom end-of-life care is a critical part of their clinical management.…”

Section: Introductionmentioning

confidence: 99%

Prognosis and management of chronic kidney disease (CKD) at the end of life

Davison

Sheerin

2013

Postgraduate Medical Journal

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The prevalence of chronic kidney disease (CKD) increases with age. As people are living longer, nephrologists are responsible for a progressively older cohort of patients with substantial comorbidities. Patients with CKD have a significant symptom burden and can benefit from intervention and symptom control from an early stage in the illness. It is also increasingly recognised that renal replacement therapy may not always offer an improvement in symptoms or a survival advantage to older patients with high levels of comorbidity. For these reasons, non-dialytic (conservative) management and end-of-life care is becoming part of routine nephrology practice. Such patients will also frequently be encountered in other specialities, requiring generalists to have some renal-specific skills and knowledge. Although there have been significant advances in this field in recent years, the optimum model of care and some of the care preferences of patients remain challenges that need to be addressed.

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“…Due to the change in demographics of ESRD, we are increasingly offering dialysis to elderly patients and patients who are likely to have diabetes, peripheral vascular disease and coronary artery disease . Planning and management of vascular access in these patients will be challenging with the physical, psychological, and social issues that occur with increased frequency in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…10 Due to the change in demographics of ESRD, we are increasingly offering dialysis to elderly patients and patients who are likely to have diabetes, peripheral vascular disease and coronary artery disease. 11 Planning and management of vascular access in these patients will be challenging with the physical, psychological, and social issues that occur with increased frequency in this group of patients. In addition, complexity of co-morbidities also increases as CKD advances leading to increase in hospital admissions and the need for venepuncture and vascular access devices at some point.…”

Section: Discussionmentioning

confidence: 99%

Improving haemodialysis fistula maturation following early ultrasound vascular mapping: ‘The Venous Preservation Scan’

et al. 2019

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Success and complication rates for AVF placement in patients who underwent VPR vs. RPOPS were 100% vs. 91.3% (P = 0.27) and 0 vs. 8.7% (P = 0.23) respectively. A greater proportion of AVF created following RPOPS required intervention before maturation compared to VPS (47.6% vs. 19%, P = 0.05). The median primary patency of AVF created following VPS vs. RPOPS was 492 (IQR 222, 1219) vs. 169 (IQR 116, 414) days (P = 0.02). The cumulative patency however did not differ between the 2 groups (median = 807 (IQR 499, 1308) vs. 1059 (IQR 331, 1263) days, P = 0.26) CONCLUSIONS: This small study suggests that VPS may favourably influence the survival of primary AVF and reduce the need for assisted interventions. However, confirmation with larger randomized controlled trial is warranted. This article is protected by copyright. All rights reserved.

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Aging and ESRD Demographics: Consequences for the Practice of Dialysis

Cited by 14 publications

References 32 publications

Serious Illness Conversations in ESRD

Serious Illness Conversations in ESRD

Prognosis and management of chronic kidney disease (CKD) at the end of life

Improving haemodialysis fistula maturation following early ultrasound vascular mapping: ‘The Venous Preservation Scan’

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