Ten tips nephrologists wish the palliative care team knew about caring for patients with kidney disease

Journal of Palliative Medicine; Apr 2018; vol. 21 (no. 4); p. 546-551
Bansal, Amar D; Leonberg-Yoo, Amanda; Schell, Jane O; Scherer, Jennifer S; Jones, Christopher A

Written by nephrologists and palliative care clinicians, this article will help PC providers to have a richer understanding of kidney disease-related symptom burden, disease trajectory, prognosis, and barriers to hospice enrollment for patients with CKD and end-stage renal disease.

Integrating supportive care principles into dialysis decision making: a primer for palliative medicine providers

Journal of Pain and Symptom Management, 2017, 53(3) 656-662

Moss, Alvin H

Because of their multiple comorbidities, high symptom burden, and limited life expectancy, CKD patients would benefit from the integration of supportive care principles into their routine care. This article addresses how supportive care specialists can collaborate with nephrology clinicians to provide patient-centered supportive care and identifies resources to assist them.

Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease

Journal of Advanced Nursing; Oct 2016; vol. 72(10) 2389-2400

Almutary, Hayfa; Douglas, Clint; Bonner, Ann

436 people with stage 4 and 5 chronic kidney disease were recruited to explore the existence of symptom clusters in advanced chronic kidney disease. . Five symptom clusters were consistently identified across all symptom dimensions, with clusters ranging from 2-10 symptoms. Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease.

Barriers and facilitators to end-of-life communication in advanced chronic organ failure

International Journal of Palliative Nursing, May 2016, vol. 22, no. 5, p. 222-229

Van den Heuvel, Liza Amc, Spruit, Martijn A, Schols, Jos Mga, Hoving, Ciska, Wouters, Emiel Fm, Janssen, Daisy Ja

The results of this quantitative, cross-sectional study suggest that the most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate, suggesting an individual approach is needed to improve communication at the end of life.

Available in print in Arthur Rank Hospice, Brookfields Hospital

Conservative care of the elderly ckd patient: a practical guide

Advances in Chronic Kidney Disease, Jan 2016, vol. 23, no. 1, p. 51-56 

Raghavan, Divya, Holley, Jean L

Palliative or supportive care should be routine for conservatively managed CKD patients. Decision-making about dialysis or conservative management requires patients and families be given information on prognosis, quality of life on dialysis, and options for supportive care. Advance care planning is the process by which these issues can be explored. Patients with ESRD have a high symptom burden, which needs to be addressed in any treatment plan. Common symptoms include pain, fatigue, insomnia, pruritus, anorexia, and nausea. Recommendations for management are discussed in the article. 

Fulltext available in Advances in Chronic Kidney Disease

Predicting palliative care needs and mortality in end stage renal disease: use of an at-risk register

BMJ Supportive and Palliative Care, March 2015, 5(1) 19-25
Kennedy Feyi, Sarah Klinger, Georgina Pharro, Liz Mcnally, Ajith James, Kate Gretton, Michael K Almond

This research used the GSF `surprise question' to formulate a list of patients predicted to die within 1 year with end stage renal failure. The authors conclude that these patients can be accurately identified by a multi-disciplinary team using the surprise trigger question with a relatively high sensitivity and specificity. The accurate identification of patients with reduced life expectancy allows appropriate end of life care planning to begin in keeping with patients' wishes and within published guidelines.

Fulltext available in BMJ Supportive and Palliative Care
Available in print in Arthur Rank House Library, Brookfields Hospital

Efficacy and safety of gabapentin for uremic pruritus and restless legs syndrome in conservatively managed patients with chronic kidney disease

Journal of Pain and Symptom Management, Apr 2015, vol. 49, no. 4, p. 782-789

Cheikh Hassan, Hicham I, Brennan, Frank, Collett, Gemma, Josland, Elizabeth A, Brown, Mark A

The authors of this study conclude that gabapentin is a viable treatment for conservatively managed CKD and ESKD patients with pruritus and/or RLS, but side effects are common. Gabapentin should be used with caution although higher doses do not appear to be a factor associated with side effects.

Fulltext available in Journal of Pain and Symptom Management

Available in print in Arthur Rank House Library, Brookfields Hospital

The power of advance care planning in promoting hospice and out-of-hospital death in a dialysis unit

Journal of Palliative Medicine, January 2015, vol./is. 18/1(62-6)

Schmidt RJ, Weaner BB, Long D

This study found that comprehensive and systematic advance care planning among patients with ESRD on dialysis promotes greater hospice utilization and may facilitate the chance that death will occur out of hospital.