The Case for ‘‘Palliative Dialysis’’

Baumrucker, Steven J.; Carter, Gregory T.; Stolick, Matt; Oertli, Karrie A.; Sheldon, Joanne E.; Morris, Gerald M.

doi:10.1177/1049909109339618

Cited by 3 publications

(3 citation statements)

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“…Mr. K was a bedbound 65-year old patient with ESRD on HD who had multiple comorbidities and was rapidly declining [ 13 ]. He had come to the conclusion that he was “ready to die” and sought a hospice.…”

Section: Discussionmentioning

confidence: 99%

Clinical excellence in nephrology: Examples from the published literature

et al. 2015

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BackgroundProvision of exceptional medical care is a goal for the medical profession because this is what the public needs and deserves. Academic medical centers that value excellent clinicians may have the best chance to recruit and retain these faculty members. When our institution hoped to launch the Miller Coulson Academy of Clinical Excellence to measure and reward master clinicians, a critical first step was to use rigorous methods to develop a definition of clinical excellence. Published papers have illustrated that this general definition of clinical excellence is applicable to fields of psychiatry, cardiology, and pediatrics.SummaryIn this manuscript, we apply the definition of clinical excellence to nephrology. Using the same framework, we reviewed the literature to find clinical cases and exemplary nephrologists that highlight the specific domains. This collection of reports in nephrology illustrates that the definition of clinical excellence set forth by the Miller Coulson Academy is highly applicable to physicians caring for individuals with kidney disease. Relating the definition of clinical excellence to renal medicine is worthwhile in that it can help to exemplify the model to which physicians and trainees may seek to aspire.Key messageMany examples of clinical excellence in renal medicine can be found in the published medical literature. The domains of clinical excellence, described by the Miller-Coulson Academy of Clinical Excellence, apply very well to the field of nephrology.

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Section: Discussionmentioning

confidence: 99%

Clinical excellence in nephrology: Examples from the published literature

et al. 2015

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“…Palliative dialysis would lessen the intensity of symptoms and increase patients' physical, social, and mental functioning while avoiding the above-mentioned complications of chronic dialysis. 6 The goal is to consider dialysis only as needed for symptom relief in palliative care patients with ESRD.…”

Section: Introductionmentioning

confidence: 99%

Palliative Dialysis in End-Stage Renal Disease

Trivedi

2011

Am J Hosp Palliat Care

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Dialysis patients are often denied hospice benefits unless they forego dialysis treatments. However, many of those patients might benefit from as-needed dialysis treatments to palliate symptoms of uremia, fluid overload, etc. The current Medicare payment system precludes this "palliative dialysis" except in those few cases where the terminal diagnosis is unrelated to renal failure. As approximately three quarters of all US patients on dialysis have Medicare as their primary insurance, a of review of Medicare policy is suggested, with a goal of creating a new "palliative dialysis" category that would allow patients to receive treatments on a less regular schedule without affecting the quality statistics of the dialysis center.( 1 ).

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“…Such patients may have difficulty tolerating conventional dialysis regimens, and conversations with patients about preferences and goals of care are warranted. While a discussion of dialysis withdrawal may be considered, many patients and family members may not feel ready to discontinue dialysis completely because of concerns about suffering from ESRD-related symptoms or death within the mean 8-day time frame following dialysis cessation in patients with no residual kidney function (26,(29)(30)(31). A palliative approach would not inevitably lead to withdrawal but could provide a transition to this option.…”

Section: Appropriate Use Of 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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The Case for ‘‘Palliative Dialysis’’

Cited by 3 publications

References 1 publication

Clinical excellence in nephrology: Examples from the published literature

Clinical excellence in nephrology: Examples from the published literature

Palliative Dialysis in End-Stage Renal Disease

A Palliative Approach to Dialysis Care

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