Hong Kong Journal of Nephrology
Volume 12, Issue 1 , Pages 31-36, April 2010

Supportive Management in Patients With End-stage Renal Disease: Local Experience in Hong Kong

Renal Unit, Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong SAR

Article Outline

We report a retrospective observational study on supportive care services in a local renal center. Seventy-four patients who had opted for supportive management after renal replacement therapy assessments in 2008 were included in the study. They were older with more comorbidities than those who had opted for dialysis. Their reported symptoms on subsequent visits were recorded. Patients and their families had a realistic acceptance of death, as reflected by the high preference for do-not-resuscitate orders on their final admission. This demonstrates the importance of structured multidisciplinary renal replacement therapy assessment with advanced care planning in the management of patients with end-stage renal disease.

Key words:  end-stage renal disease , palliative care , renal replacement therapy assessment

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. United States Renal Data System  . Annual Data Report 2009. Volume Two: Atlas of End-Stage Renal Disease in the United States. Chapter 2—Incidence and Prevalence . Available at http://www.usrds.org/adr.htm [Date accessed: March 21, 2010]
  2. Chandra SM , Shulz J , Lawrence C , Greenwood RN , Farrington K . Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity . Br Med J . 1999;318:217–223
  3. Smith C , DaSilva-Gare M , Chandra S . Choosing not to dialyse: evaluation of planned non-dialytic management in a cohort of patients with end stage renal failure . Nephron Clin Pract . 2003;95:c40–c46
  4. Kurella Tamura M , Covinsky KE , Chertow GM , Yaffe K , Landefeld CS , McCulloch CE . Functional status of elderly adults before and after initiation of dialysis . N Engl J Med . 2009;361:1539–1547
  5. Davison SN . End-of-life care preferences and needs: perceptions of patients with chronic kidney disease . Clin J Am Soc Nephrol . 2010;5:195–204
  6. Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, et al  Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease . J Am Soc Nephrol . 2006;17:2937–2944 Erratum in: J Am Soc Nephrol 2006;17:3540.
  7. 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 . 2009;23:111–119
  8. 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 . 2006;20:631–636
  9. Galla JH . Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. The Renal Physicians Association and the American Society of Nephrology . J Am Soc Nephrol . 2000;11:1340–1342
  10. Davison SN , Simpson C . Hope and advance care planning in patients with end stage renal disease: qualitative interview study . BMJ . 2006;333:886
  11. Levy JB , Chambers EJ , Brown EA . Supportive care for the renal patient . Nephrol Dial Transplant . 2004;19:1357–1360
  12. Germain MJ , Cohen LM , Davison SN . Withholding and withdrawal from dialysis: what we know about how our patients die . Semin Dial . 2007;20:195–199

PII: S1561-5413(10)60006-3

doi:10.1016/S1561-5413(10)60006-3

Hong Kong Journal of Nephrology
Volume 12, Issue 1 , Pages 31-36, April 2010