Chronic kidney disease (CKD) is, globally, a major health problem. Epidemiological data from the National Health and Nutrition Examination Survey III (NHANES III) show an increase in the prevalence of CKD in the general population, estimating that about 10% of the population in both developed and developing countries is affected by CKD.This figure is likely to be underestimated as the condition is often misunderstood. The main reasons behind this «epidemic» increase are:
— the aging of the population (the over-seventies and the over eighty in 2010, in Italy, represented respectively 55% and 20% of patients on chronic dialysis treatment);
— the increased incidence of comorbidities at high risk of developing renal impairment (such as type II diabetes mellitus, metabolic syndrome, arterial hypertension, obesity, dyslipidemia)
— the greater attention that is paid to the diagnosis of this disease, facilitated by the availability of simple, reliable and low-cost diagnostic tools;
— the increase in the average life span linked to progress in the diagnostic-therapeutic field [1, 2]
In the face of these data, a correct prognostic evaluation of the patient suffering from CKD becomes fundamental.In particular, in elderly subjects and those with multiple comorbidities, dialysis treatment is more often associated with limited survival and a significant deterioration in quality of life [1]
The unfavourable prognostic factors in patients with advanced chronic kidney disease, which allow to identify the need for palliative care, are:
— negative answer to the surprising question;
— advanced age;
— type and severity of associated comorbidities (Charlson Comorbidity Index> 8);
— severe malnutrition (albuminemia less than 2.5 g/dL);
— severe cognitive impairment;
— reduced functional autonomy (KPS <40%);
— occurrence of sentinel events (repeated hospitalizations) [1]
The Renal Physicians Association Guidelines propose to consider non-initiation or discontinuation of dialysis in the presence of severe dementia, terminal illness due to non-renal causes, and in those patients over 75 years of age and at least 2 other poor prognostic factors. above[3].In these cases it is not a question of proposing a «non-treatment» but rather a path of global care of the patient and the family unit, integrating nephrological care with the assessment of needs and the treatment of symptoms, in order to guarantee the best possible quality of life. The possibility of presenting a patient with conservative non-dialysis therapy is an increasingly frequent option given the demographic and clinical characteristics of people who develop terminal uremia for whom dialysis is often not the most appropriate choice [1, 4]
The course of CKD is generally very long. characterized by a continuous and stable care relationship. There are some ethically critical steps in this path, in particular the choice not to start a dialysis treatment rather than to suspend an ongoing treatment. In this evolutionary and complex framework from the point of view of multiple needs, collaboration between Specialist and Palliative Care Unit is essential in order to optimize symptom control, communication with patients and families and the sharing of care plans, as suggested by the shared SICP-SIN document «Palliative care in people with advanced chronic kidney disease».
Access to the site is restricted and reserved for healthcare professionals
You have reached the maximum number of visits
Source — https://www.univadis.it/viewarticle/cure-palliative-in-nefrologia-quando-e-come