Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

Fliss E M Murtagh, Aine Burns, Olivier Moranne, Rachael L Morton, Saraladevi Naicker, Fliss E M Murtagh, Aine Burns, Olivier Moranne, Rachael L Morton, Saraladevi Naicker

Abstract

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.

Keywords: Advance Care Planning; Australia; Canada; Chronic; Comorbidity; Heart Diseases; Humans; Kidney Failure; Prevalence; Renal Insufficiency; chronic kidney disease; conservative care; diabetes mellitus; palliative care; patient-centered care; quality of life; renal dialysis; supportive care.

Copyright © 2016 by the American Society of Nephrology.

References

    1. Moss A: RPA revises guidelines on the use of dialysis. Nephrol News Issues 24: 66–70, 2010
    1. Moss AH: Shared decision-making in dialysis: The new RPA/ASN guideline on appropriate initiation and withdrawal of treatment. Am J Kidney Dis 37: 1081–1091, 2001
    1. Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, Murtagh FE, Naicker S, Germain MJ, O’Donoghue DJ, Morton RL, Obrador GT; Kidney Disease: Improving Global Outcomes: Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: Developing a roadmap to improving quality care. Kidney Int 88: 447–459, 2015
    1. The Australian Institute of Health and Welfare: End Stage Kidney Disease in Australia: Total Incidence, 2003–2007. Final Report. Catalogue No. PHE 143, Canberra, New South Wales, Australia, Australian Institute of Health and Welfare, 2011
    1. Hemmelgarn BR, James MT, Manns BJ, O’Hare AM, Muntner P, Ravani P, Quinn RR, Turin TC, Tan Z, Tonelli M; Alberta Kidney Disease Network: Rates of treated and untreated kidney failure in older vs younger adults. JAMA 307: 2507–2515, 2012
    1. Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Fraenkel MB, Harris A, Johnson DW, Kesselhut J, Li JJ, Luxton G, Pilmore A, Tiller DJ, Harris DC, Pollock CA; IDEAL Study: A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 363: 609–619, 2010
    1. Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP: CKD in elderly patients managed without dialysis: Survival, symptoms, and quality of life. Clin J Am Soc Nephrol 10: 260–268, 2015
    1. Tong A, Cheung KL, Nair SS, Kurella Tamura M, Craig JC, Winkelmayer WC: Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. Am J Kidney Dis 63: 913–927, 2014
    1. Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW, Howard K: Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ 184: E277–E283, 2012
    1. Nordio M, Limido A, Maggiore U, Nichelatti M, Postorino M, Quintaliani G; Italian Dialysis and Transplantation Registry: Survival in patients treated by long-term dialysis compared with the general population. Am J Kidney Dis 59: 819–828, 2012
    1. Joly D, Anglicheau D, Alberti C, Nguyen AT, Touam M, Grünfeld JP, Jungers P: Octogenarians reaching end-stage renal disease: Cohort study of decision-making and clinical outcomes. J Am Soc Nephrol 14: 1012–1021, 2003
    1. Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K: Choosing not to dialyse: Evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron Clin Pract 95: c40–c46, 2003
    1. Ronsberg F, Isles C, Simpson K, Prescott G: Renal replacement therapy in the over-80s. Age Ageing 34: 148–152, 2005
    1. Wong CF, McCarthy M, Howse ML, Williams PS: Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis. Ren Fail 29: 653–659, 2007
    1. Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE: Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 22: 1955–1962, 2007
    1. De Biase V, Tobaldini O, Boaretti C, Abaterusso C, Pertica N, Loschiavo C, Trabucco G, Lupo A, Gambaro G: Prolonged conservative treatment for frail elderly patients with end-stage renal disease: The Verona experience. Nephrol Dial Transplant 23: 1313–1317, 2008
    1. Ellam T, El-Kossi M, Prasanth KC, El-Nahas M, Khwaja A: Conservatively managed patients with stage 5 chronic kidney disease--outcomes from a single center experience. QJM 102: 547–554, 2009
    1. Carson RC, Juszczak M, Davenport A, Burns A: Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 4: 1611–1619, 2009
    1. Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K: Survival of elderly patients with stage 5 CKD: Comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant 26: 1608–1614, 2011
    1. Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K: Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol 7: 2002–2009, 2012
    1. Isles C, Robertson S, Almond A, Donaldson K, Clark D: The challenges of renal replacement therapy and renal palliative care in the elderly. J R Coll Physicians Edinb 41: 238–243, 2011
    1. Szeto CC, Kwan BCH, Chow KM, Pang WF, Kwong VWK, Leung CB, Li PK: Life expectancy of Chinese patients with chronic kidney disease without dialysis. Nephrology (Carlton) 16: 715–719, 2011
    1. Hussain JA, Mooney A, Russon L: Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease. Palliat Med 27: 829–839, 2013
    1. O’Connor NR, Kumar P: Conservative management of end-stage renal disease without dialysis: A systematic review. J Palliat Med 15: 228–235, 2012
    1. Oliver MJ, Quinn RR: Is the decline of peritoneal dialysis in the elderly a breakdown in the process of care? Perit Dial Int 28: 452–456, 2008
    1. Shlipak MG, Stehman-Breen C, Fried LF, Song X, Siscovick D, Fried LP, Psaty BM, Newman AB: The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis 43: 861–867, 2004
    1. Moranne O, Couchoud C, Vigneau C; PSPA Study Investigators: Characteristics and treatment course of patients older than 75 years, reaching end-stage renal failure in France. The PSPA study. J Gerontol A Biol Sci Med Sci 67: 1394–1399, 2012
    1. Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, Bowman M: Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in the medical literature. Am Fam Physician 69: 548–556, 2004
    1. Murtagh FE, Addington-Hall JM, Edmonds PM, Donohoe P, Carey I, Jenkins K, Higginson IJ: Symptoms in advanced renal disease: A cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis. J Palliat Med 10: 1266–1276, 2007
    1. Murtagh FE, Addington-Hall J, Edmonds P, Donohoe P, Carey I, Jenkins K, Higginson IJ: Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis. J Pain Symptom Manage 40: 342–352, 2010
    1. Saini T, Murtagh FE, Dupont PJ, McKinnon PM, 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 20: 631–636, 2006
    1. Murphy EL, Murtagh FE, Carey I, Sheerin NS: Understanding symptoms in patients with advanced chronic kidney disease managed without dialysis: Use of a short patient-completed assessment tool. Nephron Clin Pract 111: c74–c80, 2009
    1. Yong DS, Kwok AO, Wong DM, Suen MH, Chen WT, Tse DM: Symptom burden and quality of life in end-stage renal disease: A study of 179 patients on dialysis and palliative care. Palliat Med 23: 111–119, 2009
    1. Davison SN, Jassal SV: Supportive care: Integration of patient-centered kidney care to manage symptoms and geriatric syndromes. Clin J Am Soc Nephrol 11: 1882–1891, 2016
    1. Davison SN, Jhangri GS: Existential and supportive care needs among patients with chronic kidney disease. J Pain Symptom Manage 40: 838–843, 2010
    1. Davison SN, Jhangri GS: The relationship between spirituality, psychosocial adjustment to illness, and health-related quality of life in patients with advanced chronic kidney disease. J Pain Symptom Manage 45: 170–178, 2013
    1. Low J, Smith G, Burns A, Jones L: The impact of end-stage kidney disease (ESKD) on close persons: a literature review. NDT Plus: 1: 67–79, 2008
    1. Tonkin-Crine S, Okamoto I, Leydon GM, Murtagh FE, Farrington K, Caskey F, Rayner H, Roderick P: Understanding by older patients of dialysis and conservative management for chronic kidney failure. Am J Kidney Dis 65: 443–450, 2015
    1. Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL, Michael B, O’Hare AM, Schaefer HM, Shaffer RN, Trachtman H, Weiner DE, Falk AR; American Society of Nephrology Quality, and Patient Safety Task Force: Critical and honest conversations: The evidence behind the “Choosing Wisely” campaign recommendations by the American Society of Nephrology. Clin J Am Soc Nephrol 7: 1664–1672, 2012
    1. Morton RL, Tamura MK, Coast J, Davison SN: Supportive care: Economic considerations in advanced kidney disease. Clin J Am Soc Nephrol 11: 1915–1920, 2016

Source: PubMed

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