ANZSN Renal Supportive Care Guidelines 2013

Brown, Mark; Crail, Susan; Masterson, Rosemary; Foote, Celine; Robins, Jennifer; Katz, Ivor; Josland, Elizabeth; Brennan, Frank; Stallworthy, Elizabeth J; Siva, Brian; Miller, Cathy; Urban, A; Sajiv, Cherian; Glavish, R Naida; May, Steve; Langham, Robyn G; Walker, Robert; Fassett, Robert G.; Morton, Rachael L.; Stewart, Cameron; Phipps, Lisa; Healy, Helen; Berquier, I.

doi:10.1111/nep.12065

Cited by 58 publications

(70 citation statements)

References 145 publications

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“…These patients had a lower survival than (younger) patients attending the predialysis clinic but there was no significant difference in their adjusted survival compared with dialysis patients who had not attended the predialysis clinic. Considerations in recommending dialysis to elderly patients have been addressed by the RPA (13) and others (1,5,(21)(22)(23)(24)(25)(26). Because our nephrologists broadly use these considerations, it is not surprising that patients managed in the RSC clinic were not only older but also had more comorbidities and poorer nutrition.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, survival of elderly dialysis patients is generally worse than that for most cancers (5)(6)(7). The most common cause of death on dialysis in Australia appears to be withdrawal for psychosocial or progressive medical reasons, particularly for patients aged .65 years (2), suggesting that the initial choice of treatment may have been suboptimal for many patients.…”

Section: Introductionmentioning

confidence: 99%

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CKD in Elderly Patients Managed without Dialysis

Brown

Collett

Josland

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Survival, symptom burden, and quality of life (QOL) are uncertain for elderly patients with advanced CKD managed without dialysis. We examined these outcomes in patients managed with renal supportive care without dialysis (RSC-NFD) and those planned for or commencing dialysis.Design, setting, participants, & measurements In this prospective observational study, symptoms were measured using the Memorial Symptom Assessment Scale and the Palliative care Outcomes Scale -Symptoms (renal) inventory and QOL was measured using the Short Form-36 survey. This study comprised 273 predialysis patients who had usual nephrology care and 122 nondialysis pathway patients who also attended a renal supportive care clinic adding the skills of a palliative medicine team. A further 72 patients commenced dialysis during this period without attending either clinic.Results Nondialysis patients were older than the predialysis group (82 versus 67 years; P,0.001) but had similar eGFR at the first clinic visit (16 ml/min per 1.73 m 2 ; P=0.92). Of the predialysis patients, 92 (34%) commenced dialysis. Compared with the RSC-NFD group, the death rate was lower in the predialysis group who did not require dialysis (hazard ratio, 0.23; 95% confidence interval, 0.12 to 0.41] and in those requiring dialysis (0.30; 0.13 to 0.67) but not in dialysis patients who had not attended the predialysis clinic (0.60; 0.35 to 1.03). Median survival in RSC-NFD patients was 16 (interquartile range, 9, 37) months and 32% survived .12 months after eGFR fell below 10 ml/min per 1.73 m 2 . For the whole group, age, serum albumin, and eGFR ,15 ml/min per 1.73 m 2 were associated with poorer survival. Of the nondialysis patients, 57% had stable or improved symptoms over 12 months and 58% had stable or improved QOL.Conclusions Elderly patients who choose not to have dialysis as part of shared decision making survive a median of 16 months and about one-third survive 12 months past a time when dialysis might have otherwise been indicated. Utilizing the skills of palliative medicine helps provide reasonable symptom control and QOL without dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CKD in Elderly Patients Managed without Dialysis

Brown

Collett

Josland

et al. 2015

Clinical Journal of the American Society of Nephrology

Self Cite

183

229

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“…The use of validated scales may therefore be useful for standardising the evaluation of symptoms and monitoring the healthcare outcomes of these patients [9]. Because of the variety of symptoms that might be suffered by a kidney patient, tools that can evaluate a wide range of symptoms are recommended.…”

Section: Introductionmentioning

confidence: 99%

Spanish modified version of the palliative care outcome scale–symptoms renal: cross-cultural adaptation and validation

Sánchez¹,

Leiva-Santos

Sánchez-Hernández³

et al. 2016

BMC Nephrol

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BackgroundPatients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4–5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire.MethodsThe English version of the POS-S Renal was culturally adapted and translated into Spanish using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was pilot-tested in 30 patients. A total of 200 patients with CKD stage 4–5 filled in a modified Spanish version of the POS-S Renal and the MSAS-SF. Statistical analysis to evaluate the psychometric properties of the questionnaire was carried out.ResultsThe content validity index (CVI) was 0.97, which indicated that the content of the instrument is an adequate reflection of the symptoms in advanced CKD (ACKD). The factor analysis indicated a two-factor solution explaining 35.05% of total variance. The confirmatory factor analysis (CFA) demonstrated that the two factor model was well supported (comparative fit index = 0.98, root mean square error of approximation = 0.068). This assessment tool demonstrated a satisfactory test–retest reliability (r = 0.909 to factor 1, r = 0.695 to factor 2, r = 0.887 to total score), good internal consistency to factor 1 (α = 0.78) and moderate internal consistency to factor 2 (α = 0.56). Concurrent criterion-related validity with MSAS-SF was also demonstrated, with r = 0.860, which indicated a high degree of correlation with a validated instrument that has been used in patients with ACKD.ConclusionsThe Spanish modified version of the POS-S Renal is a reliable and valid instrument that can be used to assess symptoms in Spanish patients with CKD stage 4–5.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0402-8) contains supplementary material, which is available to authorized users.

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“…2 Survival on dialysis therapy for an average 60-yearold patient is worse than that for most cancers and fairly similar to that for heart failure. 3 Unplanned dialysis in the elderly has an even worse prognosis because in-hospital mortality is 50% in patients older than 80 years and 34% in patients aged 60 to 70 years. 4 In addition, there is high symptom burden for dialysis patients and those with chronic kidney disease stage 5 managed without dialysis.…”

mentioning

confidence: 99%

“…Second, ACP means different things to different nephrologists, patients, and families. It should be a patient-centered discussion that involves families and significant others to help understand how their illness might affect them, identify goals of care, and establish how medical treatment might help patients and families achieve these goals (Stallworthy, in 3 ). This benefits surrogate decision makers as well as patients, with a proven reduction in anxiety, depression, and posttraumatic stress disorder.…”

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confidence: 99%

Planning Dialysis Care: You Might Be “Surprised”

Brown

2016

American Journal of Kidney Diseases

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ANZSN Renal Supportive Care Guidelines 2013

Cited by 58 publications

References 145 publications

CKD in Elderly Patients Managed without Dialysis

CKD in Elderly Patients Managed without Dialysis

Spanish modified version of the palliative care outcome scale–symptoms renal: cross-cultural adaptation and validation

Planning Dialysis Care: You Might Be “Surprised”

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