Kidney supportive care: an update of the current state of the art of palliative care in CKD patients  <span class="so-article-trans-title"> Translated title: Cuidados de suporte renal: uma atualiza&ccedil;&atilde;o da situa&ccedil;&atilde;o atual dos cuidados paliativos em pacientes com DRC </span>

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ABSTRACT

Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.

RESUMO

A doença renal crônica (DRC) tornou-se um peso na saúde pública em todo o mundo por sua crescente incidência e prevalência, seu alto impacto na qualidade de vida relacionada à saúde (QVRS) e na expectativa de vida, e alto custo pessoal e social. Pacientes com DRC avançada, em diálise ou não, sofrem de uma carga de sintomas muito semelhantes aos de outras doenças crônicas, e têm uma sobrevida não superior àquela de muitas doenças malignas. Assim, nos últimos anos, recomenda-se que os cuidados paliativos renais sejam integrados aos cuidados tradicionais prestados a essa população. Este trabalho fornece uma visão geral atualizada sobre os cuidados paliativos renais discutidos na literatura relevante.

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Early palliative care for patients with metastatic non-small-cell lung cancer.

Jennifer Temel, Joseph A. Greer, Alona Muzikansky … (2010)

Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.)

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Functional status of elderly adults before and after initiation of dialysis.

Manjula Kurella Tamura, Kenneth E. Covinsky, Glenn Chertow … (2009)

It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status. 2009 Massachusetts Medical Society

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The prevalence of symptoms in end-stage renal disease: a systematic review.

Fliss E M Murtagh, Julia Addington-Hall, Irene J Higginson (2007)

Symptoms in end-stage renal disease (ESRD) are underrecognized. Prevalence studies have focused on single symptoms rather than on the whole range of symptoms experienced. This systematic review aimed to describe prevalence of all symptoms, to better understand total symptom burden. Extensive database, "gray literature," and hand searches were undertaken, by predefined protocol, for studies reporting symptom prevalence in ESRD populations on dialysis, discontinuing dialysis, or without dialysis. Prevalence data were extracted, study quality assessed by use of established criteria, and studies contrasted/combined to show weighted mean prevalence and range. Fifty-nine studies in dialysis patients, one in patients discontinuing dialysis, and none in patients without dialysis met the inclusion criteria. For the following symptoms, weighted mean prevalence (and range) were fatigue/tiredness 71% (12% to 97%), pruritus 55% (10% to 77%), constipation 53% (8% to 57%), anorexia 49% (25% to 61%), pain 47% (8% to 82%), sleep disturbance 44% (20% to 83%), anxiety 38% (12% to 52%), dyspnea 35% (11% to 55%), nausea 33% (15% to 48%), restless legs 30% (8%to 52%), and depression 27% (5%to 58%). Prevalence variations related to differences in symptom definition, period of prevalence, and level of severity reported. ESRD patients on dialysis experience multiple symptoms, with pain, fatigue, pruritus, and constipation in more than 1 in 2 patients. In patients discontinuing dialysis, evidence is more limited, but it suggests they too have significant symptom burden. No evidence is available on symptom prevalence in ESRD patients managed conservatively (without dialysis). The need for greater recognition of and research into symptom prevalence and causes, and interventions to alleviate them, is urgent.

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Author and article information

Journal

Journal ID (nlm-ta): J Bras Nefrol

Journal ID (iso-abbrev): J Bras Nefrol

Journal ID (publisher-id): jbn

Title: Jornal Brasileiro de Nefrologia

Publisher: Sociedade Brasileira de Nefrologia

ISSN (Print): 0101-2800

ISSN (Electronic): 2175-8239

Publication date (Electronic): 04 September 2020

Publication date (Print): Jan-Mar 2021

Volume: 43

Issue: 1

Pages: 74-87

Affiliations

[1 ]Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.

[2 ]Hospital Santa Paula, São Paulo, SP, Brasil.

[3 ]Universidade Federal do Paraná, Hospital das Clínicas, Curitiba, PR, Brasil.

[4 ]Clínica de Hemodiálise, São Paulo, SP, Brasil.

[5 ]Sociedade Brasileira de Nefrologia Mineira, Belo Horizonte, MG, Brasil.

[6 ]Felício Rocho Hospital, Departamento de Nefrologia, Belo Horizonte, MG, Brasil.

[7 ]Instituto Dante Pazzanese de Cardiologia, Nefrologia e Hipertensão e Pós-Graduação, São Paulo, SP, Brasil.

[8 ]HCor, São Paulo, SP, Brasil.

Author notes

Correspondence to: Alze Pereira dos Santos Tavares. E-mail: alze.tavares@ 123456santapaula.com.br

AUTHOR’S CONTRIBUTION

All authors contributed equally to this work.

CONFLICT OF INTEREST

All authors declare that they have no conflict of interest related to the publication of this manuscript.

Author information

Alze Pereira dos Santos Tavares http://orcid.org/0000-0003-0783-0106

Carmen Tzanno-Martins http://orcid.org/0000-0002-7839-1828

Article

DOI: 10.1590/2175-8239-JBN-2020-0017

PMC ID: 8061961

PubMed ID: 32897286

SO-VID: 768ccebc-5e2f-48c7-b343-c553e4abad4a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License

History

Date received : 17 February 2020

Date accepted : 06 July 2020

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Kidney supportive care: an update of the current state of the art of palliative care in CKD patients Translated title: Cuidados de suporte renal: uma atualização da situação atual dos cuidados paliativos em pacientes com DRC

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Most cited references 110

Early palliative care for patients with metastatic non-small-cell lung cancer.

Functional status of elderly adults before and after initiation of dialysis.

The prevalence of symptoms in end-stage renal disease: a systematic review.

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