Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease
Identifieur interne : 000592 ( Pmc/Checkpoint ); précédent : 000591; suivant : 000593Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease
Auteurs : Fliss E. M. Murtagh [Royaume-Uni] ; Aine Burns [Royaume-Uni] ; Olivier Moranne [France] ; Rachael L. Morton [Australie] ; Saraladevi Naicker [Afrique du Sud]Source :
- Clinical Journal of the American Society of Nephrology : CJASN [ 1555-9041 ] ; 2016.
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.
Url:
DOI: 10.2215/CJN.04840516
PubMed: 27510453
PubMed Central: 5053791
Affiliations:
- Afrique du Sud, Australie, France, Royaume-Uni
- Angleterre, Gauteng, Grand Londres, Languedoc-Roussillon, Nouvelle-Galles du Sud, Occitanie (région administrative)
- Johannesbourg, Londres, Montpellier, Nîmes, Sydney
- Université de Sydney, Université du Witwatersrand
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PMC:5053791Le document en format XML
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<front><div type="abstract" xml:lang="en"><p>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.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin J Am Soc Nephrol</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Moving Points in Nephrology</subject>
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<title-group><article-title>Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease</article-title>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Murtagh</surname>
<given-names>Fliss E.M.</given-names>
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<xref ref-type="aff" rid="aff1">*</xref>
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<given-names>Aine</given-names>
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<xref ref-type="aff" rid="aff2"><sup>†</sup>
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<contrib contrib-type="author"><name><surname>Moranne</surname>
<given-names>Olivier</given-names>
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<xref ref-type="aff" rid="aff3"><sup>‡</sup>
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<xref ref-type="aff" rid="aff4"><sup>§</sup>
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<contrib contrib-type="author"><name><surname>Morton</surname>
<given-names>Rachael L.</given-names>
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<xref ref-type="aff" rid="aff5"><sup>‖</sup>
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<xref ref-type="aff" rid="aff6"><sup>¶</sup>
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<aff id="aff1"><label>*</label>
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, United Kingdom;</aff>
<aff id="aff2"><label>†</label>
Department of Nephrology, Royal Free Hospital National Health Service Foundation Trust, London, United Kingdom;</aff>
<aff id="aff3"><label>‡</label>
Institut Universitaire de Recherche Clinique, EA2415, Epidémiologie, Biostatistiques et santé publique, Faculté de Médecine, Université de Montpellier, Montpellier, France;</aff>
<aff id="aff4"><label>§</label>
Nephrology and Dialysis Department, Centre Hospitalier Universitaire de Nimes, Nimes, France;</aff>
<aff id="aff5"><label>‖</label>
National Health and Medical Research Centre Clinical Trials Centre, University of Sydney, Sydney, Australia; and</aff>
<aff id="aff6"><label>¶</label>
Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa</aff>
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<author-notes><corresp><bold>Correspondence:</bold>
Dr. Fliss E.M. Murtagh, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine, Bessemer Road, London SE5 9PJ, United Kingdom. Email: <email>fliss.murtagh@kcl.ac.uk</email>
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<fpage>1909</fpage>
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<permissions><copyright-statement>Copyright © 2016 by the American Society of Nephrology</copyright-statement>
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<abstract><p>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.</p>
</abstract>
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