Palliative Care Consultation in Advanced Chronic Kidney Disease with Pain

Chan, Kwok Ying; Yap, Desmond Y H; Yip, Terence; Sham, Mau Kwong; Lui, Sing Leung; Chan, Tak Mao

doi:10.1089/jpm.2017.0505

Cited by 8 publications

(27 citation statements)

References 25 publications

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“…Details of the 40 included studies 14-53 are reported in Table 2 and include data from 963 269 patients from 21 countries. Out of the 40 studies, 17 included a prevalence measure of overall analgesic use, 14,16-18,20,23,25,29,33,36,37,43,45,46,48,49,52 33 included a prevalence measure of one or more specific analgesic drug class, defined as opioid, NSAID, adjuvant, and nonopioid, 14-24,…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 40 studies, 17 included a prevalence measure of overall analgesic use, 14,16-18,20,23,25,29,33,36,37,43,45,46,48,49,52 33 included a prevalence measure of one or more specific analgesic drug class, defined as opioid, NSAID, adjuvant, and nonopioid, 14-24,26-28,30-47,50 and 18 measured the prevalence of one or more specific analgesic drug, including acetaminophen. 14-16,19,20,22,30,33,36-40,43,48,50,51,…”

Section: Resultsmentioning

confidence: 99%

“…However, in all cases heterogeneity remained extremely high. Due to the smaller number of studies available to analyze acetaminophen and adjuvant use, as well as the data characterized as nonopioid, weak opioid, or strong opioid, many Overall analgesic 14,[16][17][18]20,23,25,29,33,36,37,43,45,46,48,49,52 17 50.8% (38.3%-63.3%) 99.4% Opioid [14][15][16]18,19,21,24,26,31,37,38,40,44 13 23.8% (15.2%-33.7%) 100.0% Weak opioid a, 17,20,23,26,36,43,45,46 8 17.1% (10.8%-24.5%) 83.8% Strong opioid a, 20,26,33,36,45,46 6 6.7% (3.2%-11.2%) 74.8% NSAID 14,15,19,20,…”

Section: Table 2 (Continued)mentioning

confidence: 99%

“…14,15,19,20,22,[26][27][28]30,32,34,35,37,[39][40][41][42]47,50 A meta-analysis was also done for acetaminophen use, which included 8 studies, 14,15,19,20,33,36,37,43 and adjuvant use (5 studies). 19,20,26,36,43 Analyses were also conducted using data from the studies that characterized analgesics as nonopioids (8 studies), [16][17][18]20,23,37,38,46 weak opioids (8 studies), 17,20,23,26,36,43,45,46 and strong opioids (6 studies). 20,26,…”

Section: Details Of Included Studiesmentioning

confidence: 99%

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Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Rathwell

George

Hussain

et al. 2020

Can J Kidney Health Dis

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Background: Pain is common in patients with chronic kidney disease (CKD). Analgesics may be appropriate for some CKD patients. Objectives: To determine the prevalence of overall analgesic use and the use of different types of analgesics including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvants, and opioids in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with stage 3-5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of analgesic use, and the types of analgesics prescribed. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of analgesic use and the I2 statistic was computed to measure heterogeneity. Random-effects models were used to account for variations in study design and sample populations, and a double arcsine transformation of the prevalence variables was used to accommodate potential overweighting of studies with very large or very small prevalence measurements. Sensitivity analyses were performed to determine the magnitude of publication bias and assess possible sources of heterogeneity. Results: Forty studies were included in the analysis. The prevalence of overall analgesic use in the random-effects model was 50.8%. The prevalence of acetaminophen, NSAIDs, and adjuvant use was 27.5%, 17.2%, and 23.4%, respectively, while the prevalence of opioid use was 23.8%. Due to the possibility of publication bias, the actual prevalence of acetaminophen use in patients with advanced CKD may be substantially lower than this meta-analysis indicates. A trim-and-fill analysis decreased the pooled prevalence estimate of acetaminophen use to 5.4%. The prevalence rate for opioid use was highly influenced by 2 large US studies. When these were removed, the estimated prevalence decreased to 17.3%. Limitations: There was a lack of detailed information regarding the analgesic regimen (such as specific analgesics used within each class and inconsistent accounting for patients on multiple drugs and the use of over-the-counter analgesics such as acetaminophen and NSAIDs), patient characteristics, type of pain being treated, and the outcomes of treatment. Data on adjuvant use were very limited. These results, therefore, must be interpreted with caution. Conclusions: There was tremendous variability in the prescribing patterns of both nonopioid and opioid analgesics within and between countries suggesting widespread uncertainty about the optimal pharmacological approach to treating pain. Further research that incorporates robust reporting of analgesic regimens and links prescribing patterns to clinical outcomes is needed to guide optimal clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Table 2 (Continued)mentioning

confidence: 99%

Section: Details Of Included Studiesmentioning

confidence: 99%

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Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Rathwell

George

Hussain

et al. 2020

Can J Kidney Health Dis

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“…Our study is limited by its retrospective design and a relatively small proportion (~17%) of patients with noncancer diagnosis. Difficulty in predicting the disease trajectories for these patients with end-stage organ failure who opted for conservative treatment and lack of simple referral methods present substantial challenge in initiating ACP discussion in these subjects (26). Although the intervention resulted in an increase in ACP document completion, not all targeted patients agreed to join the ACP program.…”

Section: Discussionmentioning

confidence: 99%

Impact of structured advance care planning program on patients’ wish items and healthcare utilization

Chan¹,

Chiu²,

Yap³

et al. 2021

Ann Palliat Med

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Background: Structured advance care planning (ACP) program is an important service in the end-of-life care for patients with advanced medical illness. We pioneered a structured and coordinated ACP program for patients with advanced malignancies and end-stage organ failure in Hong Kong. This study investigated the impact of a structured ACP program on the concordance rate for patients' final wishes, patient/family satisfaction, and the number of acute admissions (AA) and length of stay (LOS) in hospital.Methods: Patients with advanced malignancy or end-stage organ failure who were able to complete ACP forms during the current admission to medical units were recruited. Patients who could not complete ACP forms or <18 years of age were excluded. The ACP program comprised the following components: (I) baseline education (workshop/role play) in ACP sessions for linked nurses of different medical units; (II) structured ACP discussions with recruited patients and their proxies during admission, after any change in clinical status, and also at monthly intervals; (III) formal structured review of patients' goals at regular team meetings; (IV) "flagging" of advance directive (AD) in hospital computer system and (V) feedback to linked nurse on the congruence of care. Mentally competent patients who did not receive ACP and matched for disease and demographics were selected as controls in a 1:2.5 ratio.Results: Two hundred forty-three patients were included for analysis between August 2016 and July 2017, of which 69 patients joined the ACP program and 174 of them did not. Two hundred and one patients (83%) had advanced cancer. All had done do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order in the ACP group. The concordance rates for patients' wishes on quality of life, end-of-life and funeral arrangements were 95%, 100% and 100% respectively. Over 70% of patients and their families (N=10) showed satisfaction with the program. The ACP group also had lower mean AA and shorter LOS (0.78±0.23 vs. 1.2±0.8 episode/patient, 4.6±1.7 vs. 7.5±2.5 days, P=0.037 and P=0.023 respectively) in the last 3 months of life compared with the non-ACP group.Conclusions: This ACP program achieved high concordance rate for patients' wish items and reduced healthcare utilization.

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The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis

Lambourg

Guthrie

Murugan

et al. 2021

Kidney International

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Palliative Care Consultation in Advanced Chronic Kidney Disease with Pain

Abstract: Pain is common in advanced CKD patients receiving palliative care. While this seems to have been underrecognized, the symptom is potentially amenable to management. We recommend routine assessment of pain burden in this patient population.

Cited by 8 publications

References 25 publications

Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Impact of structured advance care planning program on patients’ wish items and healthcare utilization

The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis

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