1. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease
- Author
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Fliss E M Murtagh, Saraladevi Naicker, Olivier Moranne, Aine Burns, Rachael L. Morton, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
- Subjects
Advance care planning ,Palliative care ,Epidemiology ,medicine.medical_treatment ,Family support ,030232 urology & nephrology ,Psychological intervention ,Comorbidity ,patient-centered care ,Conservative Treatment ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Kidney Failure ,0302 clinical medicine ,Prevalence ,Renal Insufficiency ,030212 general & internal medicine ,Chronic ,education.field_of_study ,palliative care ,3. Good health ,Hospitalization ,Survival Rate ,Nephrology ,renal dialysis ,diabetes mellitus ,Symptom Assessment ,Canada ,medicine.medical_specialty ,Heart Diseases ,End-Stage Kidney Disease ,Population ,Advance Care Planning ,03 medical and health sciences ,Quality of life (healthcare) ,medicine ,Humans ,Intensive care medicine ,education ,Dialysis ,conservative care ,Transplantation ,business.industry ,Australia ,medicine.disease ,Supportive Care ,supportive care ,quality of life ,Kidney Failure, Chronic ,business ,Moving Points in Nephrology ,chronic kidney disease ,Kidney disease - Abstract
International audience; Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care.
- Published
- 2016