Kidney supportive care: an update of the current state of the art of palliative care in CKD patients

Abstract

Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.

Kidney Supportive Care in Peritoneal Dialysis: Developing a Person-Centered Kidney Disease Care Plan

“…[1,2,3] Kidney supportive care-also termed "Kidney Palliative Care," "Renal Supportive Care," or "Renal Palliative Care" in various clinical or research settings-integrates palliative medicine principles in nephrology and focuses on providing an individualized approach to shared decision-making (SDM), which is applied throughout the course of advanced CKD and dialysis decision-making. [4,5,6] At its core, kidney supportive care is the delivery of person-centered kidney disease care and the corresponding development of a person-centered kidney care plan.…”

“…[12] For patients with progressive decline in kidney function or limited life expectancy, prioritizing short-term HRQoL, symptom control, and/or physical function over traditional solute clearance targets may also become an increasingly prominent consideration for patients and families, particularly as patients approach end of life. [4,6,12,74] Furthermore, for older patients --for whom solute clearance targets have not been validated --this may also decrease both patient dialysis burden and caregiver burden. [75] Sometimes termed "low-intensity PD" or "palliative PD", this goal-directed approach may offer an intermediate treatment option between conventional "full" dialysis and non-dialysis care.…”

Adaptações Nos Centros De Hemodiálise Para Prevenção Da Infecção Pelo Novo Coronavírus

“…No Brasil, a primeira recomendação relativa ao cuidado dos pacientes em diálise foi publicada em 1º de março de 2020 pela (13) . (14) .…”

Tecnologias Educacionais sobre Cuidados Paliativos no Instagram e no Youtube

“…Essa última pode ser modificada conforme o entendimento do paciente sobre o processo de adoecimento, a cultura e as vivências com os sintomas e os tratamentos. Dessa forma, faz-se necessária a readequação das intervenções, com base na avaliação individual por meio de instrumentos padronizados e validados (Ferreira & Pereira, 2020;Tavares et al, 2021).…”

“…Nessa fase, indica-se: o uso de hemodiálise incremental, ou seja, aquela utilizada em acordo com a função renal para controlar sintomas; diálise centrada no paciente e paliativa, que têm como finalidade a redução de efeitos do tratamento nefrológico; o uso de tratamento conservador abrangente, que consiste em intervenções para reduzir a progressão da doença renal e seus efeitos, englobando o suporte físico, social, emocional, espiritual e familiar; além do planejamento das decisões acerca dos cuidados em conjunto com o paciente, considerando o prognóstico e o tempo de vida estimado, registrando os desejos e as condutas, de forma a promover a qualidade de vida, o conforto e a dignidade diante da DRC em estágio terminal (Tavares et al, 2021).…”