Palliative Medicine Referral in Patients Undergoing Continuous Renal Replacement Therapy for Acute Kidney Injury

Okoń, Tomasz; Vats, Hemender S.; Dart, Richard A.

doi:10.3109/0886022x.2011.589946

Cited by 11 publications

(17 citation statements)

References 40 publications

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“…98 The high mortality of AKI in the setting of critical illness and the complex and emotionally laden aspects of the decisions associated with initiating or discontinuing renal support suggest that early involvement of palliative care services may be of benefit. 99 Time-limited trials of RRT may be a useful strategy in circumstances in which there is uncertainty of prognosis or when the patient or family/surrogate decision-maker are not prepared to make a definite decision regarding initiating or discontinuing RRT and other life-sustaining care. 100…”

Section: Ethical Issues In Initiating and Discontinuing Rrtmentioning

confidence: 99%

Continuous Renal Replacement Therapy

Tandukar

Palevsky

2019

Chest

222

252

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Continuous renal replacement therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly patients who are hemodynamically unstable. A variety of techniques that differ in their mode of solute clearance may be used, including continuous venovenous hemofiltration with predominantly convective solute clearance, continuous venovenous hemodialysis with predominantly diffusive solute clearance, and continuous venovenous hemodiafiltration, which combines both dialysis and hemofiltration. The present article compares CRRT with other modalities of renal support and reviews indications for initiation of renal replacement therapy, as well as dosing and technical aspects in the management of CRRT.

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Section: Ethical Issues In Initiating and Discontinuing Rrtmentioning

confidence: 99%

Continuous Renal Replacement Therapy

Tandukar

Palevsky

2019

Chest

222

252

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“…One single-center retrospective study showed a trend in delayed referral to PC for patients undergoing CRRT (41). In this cohort, a PC consult was called a median of 9 days after initiation of CRRT and longer (10 versus 4 days) in those who died (41). These results suggest that a more protracted hospital course and slower clinical decline rather than severity of renal injury trigger PC consults.…”

Section: The Role Of Pc In a Critically Ill Patient Undergoing A Tlt mentioning

confidence: 76%

“…Prognosis and decision making should consider other lifesustaining interventions as well as RRT. The complex nature of this decision in addition to the high mortality rate of AKI suggest that early involvement of PC services can benefit all of those involved (41). The evidence for TLTs is limited, and expert recommendations are few (7).…”

Section: Discussionmentioning

confidence: 99%

“…The effect of PC consultations specifically on patients on CRRT is unknown. One single-center retrospective study showed a trend in delayed referral to PC for patients undergoing CRRT (41). In this cohort, a PC consult was called a median of 9 days after initiation of CRRT and longer (10 versus 4 days) in those who died (41).…”

Section: The Role Of Pc In a Critically Ill Patient Undergoing A Tlt mentioning

confidence: 90%

“…These results suggest that a more protracted hospital course and slower clinical decline rather than severity of renal injury trigger PC consults. Of note, a PC consult was not associated with increased mortality, a common worry of clinicians (41). Current research examining ICU triggers for PC consultation focuses on patients who have a high risk of ICU or hospital death (42).…”

Section: The Role Of Pc In a Critically Ill Patient Undergoing A Tlt mentioning

confidence: 99%

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The Role of Time–Limited Trials in Dialysis Decision Making in Critically Ill Patients

Scherer

Holley

2016

Clinical Journal of the American Society of Nephrology

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Technologic advances, such as continuous RRT, provide lifesaving therapy for many patients. AKI in the critically ill patient, a fatal diagnosis in the past, is now often a survivable condition. Dialysis decision making for the critically ill patient with AKI is complex. What was once a question solely of survival now is nuanced by an individual's definition of quality of life, personal values, and short-and long-term prognoses. Clinical evaluation of AKI in the critically ill is multifaceted. Treatment decision making requires consideration of the natural evolution of the patient's AKI within the context of the global prognosis. Situations are often marked by prognostic uncertainty and clinical unknowns. In the face of these uncertainties, establishment of patient-directed therapies is imperative. A time-limited trial of continuous RRT in this setting is often appropriate but difficult to execute. Using patient preferences as a clinical guide, a proper time-limited trial requires assessment of prognosis, elicitation of patient values, strong communication skills, clear documentation, and often, appropriate integration of palliative care services. A well conducted time-limited trial can avoid interprofessional conflict and provide support for the patient, family, and staff.

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