Kidney Supportive Care for Advanced Chronic and End-stage Kidney Disease: a Retrospective Cohort Study

Overview

Journal J Nephrol

Publisher Springer

Specialty Nephrology

Date 2024 Mar 6

PMID 38446384

Authors

Angela Recchia

Roberta Casazza

Mario Cozzolino

Barbara Rizzi

Maria Cristina Pinerolo de Septis

Affiliations

Soon will be listed here.

Abstract

Background: Kidney supportive care is an interdisciplinary model of person-centred medicine, suitable for patients with advanced Chronic Kidney Disease (CKD) and with End-Stage Kidney Disease (ESKD). There is little information on routine care, and palliative care remains poorly integrated into standard nephrology care. The aim of this study was to describe our experience in integrating a palliative care approach into the nephrology care of advanced chronic and end-stage kidney disease.

Methods: A retrospective cohort study was conducted from 1 June, 2017 until 31 December, 2020 on 67 advanced CKD and ESKD patients admitted to a palliative care service.

Results: The patients' median age was 83.6 years, 62.7% were male, 16.4% had CKD stage 4 and 83.6% stage 5. Almost half (47.8%) of the patients were on kidney replacement therapy, and 52.2% were on conservative therapy. The majority (77.6%) received home-based palliative care, 17.9% hospice care and 4.5% day-hospice care. The median number of nephrologists' visits per patient was 3.5. Access to palliative care specialists was set at 100% and the median number of palliative clinicians' visits was 8. Eighty-five percent of patients did not require hospitalisation and 94% did not access to the emergency room; 86.2% of the patients died in hospice or at home.

Conclusions: This study reports on the first steps taken to change practice in nephrology, by applying the Italian guideline for an integrated pathway of palliative care in nephrology. Nephrologists' and the palliative care team created a multi- and inter-disciplinary team, sharing their professional skills to support patients in hospice or at home.

References

Davis J, Davison S . Hard choices, better outcomes: a review of shared decision-making and patient decision aids around dialysis initiation and conservative kidney management. Curr Opin Nephrol Hypertens. 2017; 26(3):205-213. DOI: 10.1097/MNH.0000000000000321. View

Saini T, Murtagh F, Dupont P, McKinnon P, Hatfield P, Saunders Y . Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease. Palliat Med. 2006; 20(6):631-6. DOI: 10.1177/0269216306070236. View

Davison S, Levin A, Moss A, Jha V, Brown E, Brennan F . Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int. 2015; 88(3):447-59. DOI: 10.1038/ki.2015.110. View

Gelfand S, Scherer J, Koncicki H . Kidney Supportive Care: Core Curriculum 2020. Am J Kidney Dis. 2020; 75(5):793-806. DOI: 10.1053/j.ajkd.2019.10.016. View

Davison S . Personalized Approach and Precision Medicine in Supportive and End-of-Life Care for Patients With Advanced and End-Stage Kidney Disease. Semin Nephrol. 2018; 38(4):336-345. DOI: 10.1016/j.semnephrol.2018.05.004. View

Lam D, Scherer J, Brown M, Grubbs V, Schell J . A Conceptual Framework of Palliative Care across the Continuum of Advanced Kidney Disease. Clin J Am Soc Nephrol. 2019; 14(4):635-641. PMC: 6450347. DOI: 10.2215/CJN.09330818. View

Chiu H, Murphy-Burke D, Thomas S, Melnyk Y, Kruthaup-Harper A, Dong J . Advancing Palliative Care in Patients With CKD: From Ideas to Practice. Am J Kidney Dis. 2020; 77(3):420-426. DOI: 10.1053/j.ajkd.2020.09.012. View

Scherer J, Harwood K, Frydman J, Moriyama D, Brody A, Modersitzki F . A Descriptive Analysis of an Ambulatory Kidney Palliative Care Program. J Palliat Med. 2019; 23(2):259-263. PMC: 6987731. DOI: 10.1089/jpm.2018.0647. View

Purtell L, Sowa P, Berquier I, Scuderi C, Douglas C, Taylor B . The Kidney Supportive Care programme: characteristics of patients referred to a new model of care. BMJ Support Palliat Care. 2018; . DOI: 10.1136/bmjspcare-2018-001630. View

10.

Davison S, Moss A . Supportive Care: Meeting the Needs of Patients with Advanced Chronic Kidney Disease. Clin J Am Soc Nephrol. 2017; 11(10):1879-1880. PMC: 5053793. DOI: 10.2215/CJN.06800616. View

11.

Wachterman M, Leveille T, Keating N, Simon S, Waikar S, Bokhour B . Nephrologists' emotional burden regarding decision-making about dialysis initiation in older adults: a qualitative study. BMC Nephrol. 2019; 20(1):385. PMC: 6814056. DOI: 10.1186/s12882-019-1565-x. View

12.

Collins A, Foley R, Gilbertson D, Chen S . The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009; 4 Suppl 1:S5-11. DOI: 10.2215/CJN.05980809. View

13.

Gamblin V, Prodhomme C, Lecoeuvre A, Bimbai A, Luu J, Hazard P . Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital. BMC Palliat Care. 2021; 20(1):24. PMC: 7839201. DOI: 10.1186/s12904-021-00720-7. View

14.

Bansal A, Leonberg-Yoo A, Schell J, Scherer J, Jones C . Ten Tips Nephrologists Wish the Palliative Care Team Knew About Caring for Patients with Kidney Disease. J Palliat Med. 2018; 21(4):546-551. DOI: 10.1089/jpm.2018.0087. View

15.

Lu E, Blinderman C . Palliative Care for Patients With Advanced CKD: Moving Beyond the Status Quo. Kidney Med. 2020; 1(6):335-337. PMC: 7380352. DOI: 10.1016/j.xkme.2019.09.003. View