Palliative Dialysis in End-Stage Renal Disease

Trivedi, Disha D.

doi:10.1177/1049909111400061

Cited by 18 publications

(18 citation statements)

References 7 publications

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“…In this setting, palliative dialysis can be considered as an aspect of holistic patient care [59,61,62]. In this context, palliative dialysis should be understood as performing dialysis sessions only with the intent to alleviate symptoms of uraemia on a short-term basis.…”

Section: Advantages and Potential Dangers Of Dialysismentioning

confidence: 99%

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Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

et al. 2015

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In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.

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Section: Advantages and Potential Dangers Of Dialysismentioning

confidence: 99%

“…Sensitive discussions with the patient, its family and carers should ensue around advance care planning [70]. Such plans might include deescalation of dialysis intensity or frequency-palliative dialysis [59,62,71]-and perhaps withdrawal from dialysis in favour of a purely palliative approach [72].…”

Section: The Need For Advance Care Planningmentioning

confidence: 99%

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

et al. 2015

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“…Palliative dialysis may be useful when patients and carers are understandably ambivalent on the decision to withdraw from dialysis at the terminal phases of their illness. 26 Withdrawal of dialysis accounts for almost 20% of the mortality among dialysis patients in the USA. Conservative management of end-stage renal failure is becoming more widely accepted as an alternative option to dialysis for frail, highly dependent patients with multiple co-morbidities.…”

Section: Improving Patient Experience and Outcomes On Haemodialysismentioning

confidence: 99%

Haemodialysis

Wong¹,

Farrington²

2015

Medicine

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The haemodialysis population continues to increase and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as b 2 -microglobulin clearance, salt and water balance, and phosphate control. Haemodiafiltration provides improved b 2 -microglobulin clearance over haemodialysis, and may improve survival. There is a trend towards individualizing haemodialysis dose to the needs of the patient. Patients with significant residual kidney function may require less dialysis. For others without residual function, more frequent treatments may be necessary to adequately control uraemia and volume status, and to improve survival. Home-based treatment can facilitate more frequent treatments for a proportion of patients, although centre-based therapy remains the default for the majority.

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“…Patients have a wide spectrum of prognoses, including many with a life expectancy of ,1 year (4,5). For this group, the burdens of dialysis care may outweigh its benefits, thus making desirable a palliative approach to dialysis care in which the emphasis is shifted toward minimizing physical and psychologic burdens of standard maintenance dialysis schedules (such as fatigue and travel to and from dialysis), and away from achieving standard performance metrics (such as creation of an arteriovenous fistula or intensification of the dialysis prescription to achieve a target Kt/V) ( Figure 1) (6).…”

Section: Defining a Palliative Approach To Dialysis Carementioning

confidence: 99%

A Palliative Approach to Dialysis Care

Grubbs

Moss

Cohen

et al. 2014

Clinical Journal of the American Society of Nephrology

131

116

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As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.

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Palliative Dialysis in End-Stage Renal Disease

Cited by 18 publications

References 7 publications

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

Haemodialysis

A Palliative Approach to Dialysis Care

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