Skip to main content

Advertisement

SpringerLink
Log in

Kidney supportive care for advanced chronic and end-stage kidney disease: a retrospective cohort study

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Kidney supportive care is an interdisciplinary model of person-centred medicine, suitable for patients with advanced Chronic Kidney Disease (CKD) and with End-Stage Kidney Disease (ESKD). There is little information on routine care, and palliative care remains poorly integrated into standard nephrology care. The aim of this study was to describe our experience in integrating a palliative care approach into the nephrology care of advanced chronic and end-stage kidney disease.

Methods

A retrospective cohort study was conducted from 1 June, 2017 until 31 December, 2020 on 67 advanced CKD and ESKD patients admitted to a palliative care service.

Results

The patients’ median age was 83.6 years, 62.7% were male, 16.4% had CKD stage 4 and 83.6% stage 5. Almost half (47.8%) of the patients were on kidney replacement therapy, and 52.2% were on conservative therapy. The majority (77.6%) received home-based palliative care, 17.9% hospice care and 4.5% day-hospice care. The median number of nephrologists’ visits per patient was 3.5. Access to palliative care specialists was set at 100% and the median number of palliative clinicians’ visits was 8. Eighty-five percent of patients did not require hospitalisation and 94% did not access to the emergency room; 86.2% of the patients died in hospice or at home.

Conclusions

This study reports on the first steps taken to change practice in nephrology, by applying the Italian guideline for an integrated pathway of palliative care in nephrology. Nephrologists’ and the palliative care team created a multi- and inter-disciplinary team, sharing their professional skills to support patients in hospice or at home.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Levin A, Stevens PE, Bilous RW et al (2013) Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150. https://doi.org/10.1038/kisup.2012.73

    Article  Google Scholar 

  2. Jha V, Garcia-Garcia G, Iseki K et al (2013) Chronic kidney disease: global dimension and perspectives. The Lancet 382:260–272. https://doi.org/10.1016/S0140-6736(13)60687-X

    Article  Google Scholar 

  3. Davis JL, Davison SN (2017) Hard choices, better outcomes: a review of shared decision-making and patient decision aids around dialysis initiation and conservative kidney management. Curr Opin Nephrol Hypertens 26:205–213. https://doi.org/10.1097/MNH.0000000000000321

    Article  PubMed  Google Scholar 

  4. Lunney M, Bello AK, Levin A et al (2021) Availability, accessibility, and quality of conservative kidney management worldwide. CJASN 16:79–87. https://doi.org/10.2215/CJN.09070620

    Article  Google Scholar 

  5. Renal Physicians Association Working Group (2010) Shared decision making in the appropriate initiation and withdrawal from dialysis. RPA Clinical Practice Guideline: Second Edition 2

  6. Saini T, Murtagh FE, Dupont PJ et al (2006) Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease. Palliat Med 20:631–636. https://doi.org/10.1177/0269216306070236

    Article  CAS  PubMed  Google Scholar 

  7. Wachterman MW, Lipsitz SR, Lorenz KA et al (2017) End-of-life experience of older adults dying of end-stage renal disease: a comparison with cancer. J Pain Symptom Manag 54:789–797. https://doi.org/10.1016/j.jpainsymman.2017.08.013

    Article  Google Scholar 

  8. Sturgill D, Bear A (2019) Unique palliative care needs of patients with advanced chronic kidney disease: the scope of the problem and several solutions. Clinical Medicine. J R Coll Physicians Lond 19:26–29. https://doi.org/10.7861/clinmedicine.19-1-26

    Article  Google Scholar 

  9. WHO Palliative care. https://www.who.int/europe/news-room/fact-sheets/item/palliative-care

  10. Davison SN, Levin A, Moss AH et al (2015) Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: developing a roadmap to improving quality care. Kidney Int 88:447–459. https://doi.org/10.1038/ki.2015.110

    Article  PubMed  Google Scholar 

  11. Gelfand SL, Scherer JS, Koncicki HM (2020) Kidney supportive care: core curriculum 2020. Am J Kidney Dis 75:793–806. https://doi.org/10.1053/j.ajkd.2019.10.016

    Article  PubMed  Google Scholar 

  12. Davison SN (2018) Personalized approach and precision medicine in supportive and end-of-life care for patients with advanced and end-stage kidney disease. Semin Nephrol 38:336–345. https://doi.org/10.1016/j.semnephrol.2018.05.004

    Article  PubMed  Google Scholar 

  13. Lam DY, Scherer JS, Brown M et al (2019) A conceptual framework of palliative care across the continuum of advanced kidney disease. CJASN 14:635–641. https://doi.org/10.2215/CJN.09330818

    Article  PubMed  PubMed Central  Google Scholar 

  14. SICP-SIN (2016) Documento condiviso SICP-SIN Le Cure Palliative nelle persone con malattia renale cronica avanzata

  15. NHS (2015) Advanced-kidney-disease.pdf. https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Advanced-kidney-disease.pdf. Accessed 8 Nov 2023

  16. Chiu HH-L, Murphy-Burke DM, Thomas SA et al (2021) Advancing palliative care in patients with CKD: from ideas to practice. Am J Kidney Dis 77:420–426. https://doi.org/10.1053/j.ajkd.2020.09.012

    Article  PubMed  Google Scholar 

  17. Scherer JS, Wright R, Blaum CS, Wall SP (2018) Building an outpatient kidney palliative care clinical program. J Pain Symptom Manag 55:108-116.e2. https://doi.org/10.1016/j.jpainsymman.2017.08.005

    Article  Google Scholar 

  18. Scherer JS, Harwood K, Frydman JL et al (2020) A descriptive analysis of an ambulatory kidney palliative care program. J Palliat Med 23:259–263. https://doi.org/10.1089/jpm.2018.0647

    Article  PubMed  PubMed Central  Google Scholar 

  19. Purtell L, Sowa PM, Berquier I et al (2018) The kidney supportive care programme: characteristics of patients referred to a new model of care. BMJ Support Palliat Care. https://doi.org/10.1136/bmjspcare-2018-001630

    Article  PubMed  Google Scholar 

  20. Davison SN, Moss AH (2016) Supportive care: meeting the needs of patients with advanced chronic kidney disease. CJASN 11:1879–1880. https://doi.org/10.2215/CJN.06800616

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wachterman MW, Leveille T, Keating NL et al (2019) Nephrologists’ emotional burden regarding decision-making about dialysis initiation in older adults: a qualitative study. BMC Nephrol 20:385. https://doi.org/10.1186/s12882-019-1565-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ministero dell’Università e della Ricerca (2021) Decreto Ministeriale n. 1268 del 26-9-2023

  23. (2010) Gazzetta Ufficiale. https://www.gazzettaufficiale.it/gunewsletter/dettaglio.jsp?service=1&datagu=2010-03-19&task=dettaglio&numgu=65&redaz=010G0056&tmstp=1269600292070. Accessed 8 Nov 2023

  24. Collins AJ, Foley RN, Gilbertson DT, Chen S-C (2009) The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol 4:S5–S11. https://doi.org/10.2215/CJN.05980809

    Article  PubMed  Google Scholar 

  25. Gamblin V, Prod’homme C, Lecoeuvre A et al (2021) Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital. BMC Palliat Care 20:24. https://doi.org/10.1186/s12904-021-00720-7

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moss A (2020) Palliative care in nephrology. Oxford University Press, New York

    Book  Google Scholar 

  27. Tavares APS, Santos CGS, Tzanno-Martins C et al (2021) Kidney supportive care: an update of the current state of the art of palliative care in CKD patients. Braz J Nephrol 43:74–87. https://doi.org/10.1590/2175-8239-jbn-2020-0017

    Article  Google Scholar 

  28. Bansal AD, Leonberg-Yoo A, Schell JO et al (2018) Ten tips nephrologists wish the palliative care team knew about caring for patients with kidney disease. J Palliat Med 21:546–551. https://doi.org/10.1089/jpm.2018.0087

    Article  PubMed  Google Scholar 

  29. Lu E, Blinderman CD (2019) Palliative care for patients with advanced CKD: moving beyond the status quo. Kidney Med 1:335–337. https://doi.org/10.1016/j.xkme.2019.09.003

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the VIDAS ODV for the possibility to conduct the study, and J.D. Baggott for language editing.

Funding

The authors did not receive support from any organisation for the submitted work.

Author information

Authors and Affiliations

  1. Fondazione VIDAS, Via U. Ojetti 66, 20151, Milan, Italy

    Angela Recchia & Barbara Rizzi

  2. Renal Division, ASST Santi Paolo e Carlo, Milan, Italy

    Roberta Casazza, Mario Cozzolino & Maria Cristina Pinerolo de Septis

  3. Department of Health Sciences, University of Milan, Milan, Italy

    Mario Cozzolino

Authors
  1. Angela Recchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Casazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Cozzolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Rizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Cristina Pinerolo de Septis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in drafting the manuscript or critical revision of the manuscript for important intellectual content and gave approval for the final version submitted. Individual contributions are as follows: AR designed the study, analysed data and wrote the manuscript; RC collected the data; AR, MCPdS and BR interpreted the data; MC, MCPdS and BR carried out a final critical revision for important intellectual content. All authors approved the final version of the paper.

Corresponding author

Correspondence to Angela Recchia.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was approved by Comitato Etico Milano Area 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano and by Comitato Etico Milano Area 1.

Human and animal rights

The paper involved human participants.

Informed consent

All participants provided informed consent prior to their participation.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Recchia, A., Casazza, R., Cozzolino, M. et al. Kidney supportive care for advanced chronic and end-stage kidney disease: a retrospective cohort study. J Nephrol (2024). https://doi.org/10.1007/s40620-023-01879-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40620-023-01879-3

Keywords

Search

Navigation