title: Illness trajectories and their relevance to the care of adults with kidney disease.
abstract: OBJECTIVE
  Existing practice guidelines for chronic kidney disease advocate a stage-based approach to management, in which treatment recommendations are based largely on the severity of kidney disease, and future risk for adverse health outcomes. However, the course of kidney disease can vary widely among patients with similar levels of kidney function, and each patient will experience their illness in unique ways.
  
  
  RESULTS
  We summarize recent studies of patterns of kidney function over time among patients with chronic kidney disease, and discuss these findings in the context of relevant conceptual models of illness and communication. Although knowledge of disease severity can provide useful information on life expectancy and risk for future health events, an understanding of each patient's illness trajectory and their unique experience of illness is essential in supporting patient-centered care for patients with kidney disease. This information can be helpful in setting realistic expectations for the future, in communicating about prognosis and in aligning treatment decisions with each patient's goals and preferences.
  
  
  CONCLUSIONS
  We here explain how an understanding of illness trajectories may be useful in predicting and guiding care and decision-making in patients with kidney disease. We highlight the importance of competing disease trajectories, the heterogeneity in renal function trajectories among patients with kidney disease, and the variability in these trajectories over time in individual patients. We discuss how individual disease trajectories can shape each patient's experience of illness. Finally, we explain how an understanding of an individual patient's illness trajectory and experience of illness may be useful in guiding discussions about prognosis and treatment decisions and in supporting a patient-centered approach to care.
authors.affiliation: aSection of Palliative Care and Medical Ethics bRenal-Electrolyte Division, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania cDepartment of Medicine, VA Puget Sound Healthcare System and University of Washington, Seattle, Washington, D.C., USA.
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
authors.forename: Ann M
authors.initials: AM
authors.lastname: O'Hare
mesh_terms: D000328:Adult; D003142:Communication; D018450:Disease Progression; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055809:Illness Behavior; D007668:Kidney / Q000503:physiopathology*; D010358:Patient Participation; D057240:Patient Preference; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome