Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management.
Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients.
Royal Free Hampstead NHS Foundation Trust, London NW3 2QG, UK. sheilajohnston@nhs.net.
Sheila
S
Johnston
conservative management; palliative care; stage 5 chronic kidney disease; supportive care; symptom management
Int J Palliat Nurs. 2011 Jan;17(1):42-6
21278673
Nephrol Dial Transplant. 2001 Jan;16(1):128-33
11209006
Semin Dial. 2002 Mar-Apr;15(2):79-83
11952930
Nephrol Dial Transplant. 2004 Mar;19(3):692-701
14767028
J Palliat Med. 2007 Dec;10 (6):1266-76
18095805
Kidney Int. 2007 Jul;72 (1):92-9
17440495
Nephron Clin Pract. 2010;115 Suppl 1:c309-19
20413955
J Clin Nurs. 2005 Mar;14(3):294-300
15707439
Palliat Med. 2013 Oct;27(9):817-21
23765187