Integrating Supportive Care Principles into Dialysis Decision-Making: A Primer for Palliative Medicine Providers
Despite advances in pre-dialysis care and dialysis technology, patients with advanced chronic kidney disease and end-stage renal disease continue to experience multiple comorbidities, a high symptom burden, a shortened life expectancy and substantial physical, emotional, and spiritual suffering. Patients with acute kidney injury and end-stage renal disease, especially if they are older, often undergo prolonged hospitalizations, greater use of intensive medical treatment, and limited survival. Unfortunately, most nephrologists are not trained to conduct shared decision-making conversations to elicit patients ’ values, preferences, and goals for treatment and address their patients’ multifactorial suffering.
ConclusionThe sweet orange aromatherapy can be effective in reducing pain and anxiety. Thus, this can be used by nurses as an alternative and complementary approach to reduce both pain and anxiety in painful procedures like needle insertion.
In conclusion, the possibility of leptospirosis should be considered in patients presenting with non-specific symptoms such as fever and muscle pain and developing thrombocytopenia, and liver and kidney function disorder. Risk factors should also be investigated when taking histories. Early diagnosis and antibiotic therapy being started as quickly as possible are important in terms of the course of the disease. PMID: 32172267 [PubMed - in process]
We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the ...
Conclusion: The most commonly affected domains were usual activities (79%), pain (76.20%) and anxiety/depression (71.91%). Factors such as age (>65 yrs.), BMI (Underweight and Obese), educational background (Illiterate), Unemployment, domiciliary status (Rural), number of medications (>11) had significant association with EQ–5D index and VAS scores (p–0.000). It was found that QoL was impaired in stage 5D compared to other stages (p–0.000).
Purpose of review Cannabis (marijuana, weed, pot, ganja, Mary Jane) is the most commonly used federally illicit drug in the United States. The present review provides an overview of cannabis and cannabinoids with relevance to the practice of nephrology so that clinicians can best take care of patients. Recent findings Cannabis may have medicinal benefits for treating symptoms of advanced chronic kidney disease (CKD) and end-stage renal disease including as a pain adjuvant potentially reducing the need for opioids. Cannabis does not seem to affect kidney function in healthy individuals. However, renal function should b...
Among seriously ill patients, those with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) arguably receive among the worst end-of-life care. These patients frequently die in the hospital, often after an intensive procedure like cardiopulmonary resuscitation, and with a low referral rate to hospice. There is now a concerted effort in the nephrology and palliative care communities to integrate palliative care into the treatment of these seriously ill patients. The Pathways Project is a national demonstration, funded by the Gordon and Betty Moore Foundation, to develop scalable innovations in kidney supportive care.
Guidelines recommend advance care planning (ACP) as essential to quality chronic kidney disease (CKD) management, but the nephrology community has yet to incorporate ACP upstream of the dialysis decision. Others have attempted to improve ACP for dialysis patients, but many patients report wishing they had been engaged in ACP earlier. This project tested integration of ACP coaching in the upstream setting of nephrology offices.
The objective of this report is to describe how Ericksonian hypnosis, mindfulness meditation and compassion meditation could support chronic kidney disease patients, their caregivers and the health-care professional. PMID: 31928954 [PubMed - as supplied by publisher]
A 78-year-old male with hypertension, chronic kidney disease, and urothelial carcinoma excised 3 years prior presented with lower abdominal pain and weight loss. He had been experiencing progressive anorexia, weakness, and a 30-pound weight loss before presentation.
A case is presented which demonstrates the perils of opioid inefficacy and how pharmacogenomic testing may have prevented nonsteroidal anti-inflammatory drug (NSAID)-induced nephrotoxicity and progression to chronic kidney disease (CKD). A 62 year-old female with back pain was treated with tramadol and hydrocodone; however, neither proved effective. Consequently, to control her pain, she resorted to cocaine, marijuana, and high dose nonsteroidal anti-inflammatory drugs (NSAIDs). She eventually developed CKD. To identify CKD contributors, she underwent genotyping for Apolipoprotein L1 (APOL1), a known risk factor of CKD, as...