Where Palliative Care and Nephrology Meet —Complex Decisions in the Older CKD Patient (TH339)

Chronic kidney disease (CKD) is increasingly common in the aging population, and the highest incidence of patients starting dialysis is those 75 years of age and older. Patients over the age of 67 face mortality rates as high as 23% at 6 months, though there exists great variability. Older patients with advanced CKD are more likely to have comorbidities including cognitive and functional limitations. Symptom burden is high and does not consistently improve, and may worsen, after starting dialysis.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research

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Restless legs syndrome (RLS) is a sensorimotor disorder defined by an uncontrollable “urge to move” the limbs during rest, that is temporarily relieved by movement and cannot be explained by other medical or behavioural conditions(1). Individuals with end stage kidney disease (ESKD) are known to have a high symptom burden(2-4), which often goes unrecognised(5). Uraemic RLS is re ported to affect almost 30% of ESKD patients(6, 7) which significantly reduces quality of life and impacts upon sleep quality, ability to dialyse(8) and mortality(7, 8).
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
Purpose of review This review evaluates current recommendations for pain management in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) with a specific focus on evidence for opioid analgesia, including the partial agonist, buprenorphine. Recent findings Recent evidence supports the use of physical activity and other nonpharmacologic therapies, either alone or with pharmacological therapies, for pain management. Nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin–norepinephrine reuptake inhibitors, and TCA may be considered based on pain cause and type, wit...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: SPECIAL COMMENTARY Source Type: research
Abstract Urinothorax [UT], the accumulation of urine in the pleural space, is an uncommon cause of pleural effusions resulting from trauma, obstruction, or iatrogenic causes. Thoracentesis with pleural fluid analysis and evaluation of biochemical characteristics, such as pleural fluid creatinine (PCr) to serum creatinine ratio (Scr), is necessary to establish this diagnosis. This case illustrates a 93 year old man with a complicated past medical history including chronic kidney disease stage 4, adenocarcinoma of the prostate status post brachytherapy complicated by proctitis, high grade transitional cell carcinoma...
Source: Respiratory Care - Category: Respiratory Medicine Authors: Tags: Respir Med Case Rep Source Type: research
ConclusionComplications frequently occur in EPN patients as compared to pyelonephritis.
Source: Journal of Diabetes and Metabolic Disorders - Category: Endocrinology Source Type: research
CONCLUSION: We found a prevalence of Fabry disease in 9.47% of relatives of CKD patients with this condition, remarkably with a 66.1% predominance of women, which contrasts with previous reports. The screening of family members of FD patients is important, since it can lead to early diagnosis and treatment, thus allowing better quality of life and improved clinical outcomes for these individuals. PMID: 32930322 [PubMed - as supplied by publisher]
Source: Jornal Brasileiro de Nefrologia - Category: Urology & Nephrology Tags: J Bras Nefrol Source Type: research
ConclusionAnalgesics can be inappropriately used in patients with chronic kidney disease. For chronic kidney disease patients with postherpetic neuralgia,shichimotsukokato may have an effect on both pain and renal function and seems to be beneficial.
Source: Traditional and Kampo Medicine - Category: Complementary Medicine Authors: Tags: CASE REPORT Source Type: research
CONCLUSIONS: A single pharmacist-led education intervention to primary care providers on inappropriate NSAID use in high-risk patient populations had a significant impact on minimizing inappropriate NSAID prescribing patterns within a family medicine outpatient office. PMID: 32931009 [PubMed - in process]
Source: Famly Medicine - Category: Primary Care Authors: Tags: Fam Med Source Type: research
We describe a case of a 70-year-old woman on PD presented with moderate abdominal pain and low blood pressure, which contributed to the early diagnosis of PD-related peritonitis complicated with NOMI. Increased white cell count of 7150/ μL (neutrophil, 84%) in dialysate effluent was diagnostic of PD-related peritonitis, which was later found to be caused byPseudomonas putida. Computed tomography with contrast performed after administering crystalloids revealed hepatic portal venous gas, pneumatosis intestinalis in the ascending colon, and normal enhancement of the bowel wall and mesenteric arteries, which suggested a re...
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research
Ashima Ravindran, Rajesh Peringanazhi Kunnath, Anjali Sunny, Binoo VimalIndian Journal of Palliative Care 2020 26(3):281-286 Background: Uremic pruritus (UP) affects many patients suffering from chronic kidney disease (CKD) and has a negative impact on the quality of life. The severity of UP ranges from sporadic discomfort to complete restlessness during both day and night time. It has become increasingly evident that central transmission and sensitization processes similar to those observed in chronic pain are important mechanisms of pruritus. Methodology: This was a randomized single-blind prospective-interventional stu...
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
The efficacy and safety of cannabinoids to treat symptoms in individuals with kidney disease is uncertain.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
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