Palliative Medicine and Hospice Care · Vol. 1, No. 1 · 2015 · pp. 16–23 · e-ISSN 2377-8393

Palliative Care for Nephropathic Patients

Gianluca Villa, Sara Samoni, Paola Di Maggio, Alessandra Spinelli, Silvia De Rosa, Fabio O. Tartaglia, Iacopo Lanini, Claudio Ronco, A. Raffaele De Gaudio

Department of Health Science, Section of Anaesthesiology and Intensive Care, University of Florence, Florence, Italy; Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza, ItalyItaly
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy; Institute of Life Sciences, S. Anna School of Advanced Studies, Pisa, ItalyItaly
Department of Health Science, Section of Anaesthesiology and Intensive Care, University of Florence, Florence, ItalyItaly
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy; Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplanta- tion Unit, University of Bari, ItalyItaly
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy; Department of Intensive Care and Anaesthesiology, Catholic University of the Sacred Heart, Rome, ItalyItaly
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza, ItalyItaly

DOI: https://doi.org/10.17140/pmhcoj-1-104 · Published 2015-02-10 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2015 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

A new light has recently been shed on palliative care, especially, on its multidisci-plinary approach developed to improve the Quality of life of seriously ill patients and their families. However, palliative care is still often mistakenly referred to as an end-of-life care and wrongly interchanged with hospice care. Nephropathic patients usually present a decrease in expectancy and Quality of life and may benefit from palliative care as opposed to hospice care. Palliative care requires a tight collaboration among different health care professionals, patients and their families, to share diagnosis, prognosis, realistic goals of treatment and therapeutic decisions. Several approaches may be attempted to improve the Quality of life of chronic neph-ropathic patients, such as palliative dialysis, conservative management and peritoneal dialysis. For example, personalized goals and a wider concept of adequacy of extracorporeal treatment are the bases of palliative dialysis. In specific subgroups of frail patients, the pharmacological conservative management could be more appropriate than extracorporeal treatment, as the for-mer reduces the burdens derived from invasive procedures. Finally, peritoneal dialysis could be an important option for frail patients to avoid an aggressive extracorporeal treatment while maintaining a gentle solute and fluid control. However, only limited evidences are available on palliative and hospice care performed on patients with Acute Kidney Injury (AKI). Herein, the main variables affecting the medical decision-making on palliative care in nephropathic patients are described, and the different approaches available to improve quality of palliative care during Chronic and Acute Kidney Injury are analyzed.

Keywords: Palliative care; Hospice care; Chronic Kidney Disease; End-Stage Renal Disease; Acute Kidney Injury; Renal Replacement Therapy

Conclusions

Palliative care is usually limited to seriously ill patients at the end-of-life phase and is often wrongly interchanged with hospice care. An earlier utilization of palliative care for all seriously ill patients may improve the quality of life of the patients and their families. Nephropathic patients usually present a decrease in life expectancy and may benefit from palliative care.

Although limited to end stages of the renal disease, the concept of palliative care is still better defined for CKD than AKI patients. Indeed, several therapeutic strategies may be attempted to improve Quality of life of chronic nephropathic patients, such as palliative dialysis, conservative management and PD. All these approaches require a tight collaboration between different healthcare professional figures, patients and their families. Prognosis, realistic treatment goals and therapeutic decisions should be shared among all subjects involved in the management of CKD. On the other hand, poor literature data are available on the effects of palliative and hospice care in patients with AKI. A methodological, ethical and clinical effort needs to be made to improve knowledge and awareness on palliative care in acute nephropathic patients.

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