Skip to main content

Palliation with Dual Burden of Heart and Kidney Failure: An Underutilized Strategy

  • Chapter
  • First Online:
  • 1436 Accesses

Abstract

Cardio-renal disease as a disease entity carries with it high morbidity and mortality. This entity is only now being defined and studied, and much of the treatment of these patients is guided by what is known of patient populations with heart failure or kidney failure. There are few disease specific treatments available for CRS and much of the care is focused on symptom management, and is characterized by very high morbidity and mortality burden. Palliative care as a specialty was recognized by the American Board of Medical Specialties in 2006. Given the high symptom burden and complexity of outcomes with the overlap of heart and kidney disease, palliative care is integral to the multi-disciplinary effort required in achieving optimal outcomes in these patients.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bock JS, Gottlieb SS. Cardiorenal syndrome, new perspectives. Circulation. 2010;121:2592–600. doi:10.1161/CIRCULATIONAHA.109.886473.

    Article  PubMed  Google Scholar 

  2. Shlipak M, Massie BM. The clinical challenge of cardiorenal syndrome. Circulation. 2004;110:1514–7.

    Article  PubMed  Google Scholar 

  3. Liu PP. Cardiorenal syndrome in heart failure: a cardiologist’s perspective. Can J Cardiol. 2008;24(Suppl B):25B–9B.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Liang KV, Williams AW, Greene EL, Redfield MM. Acute decompensated heart failure and the cardiorenal syndrome. Crit Care Med. 2008;36(1 Suppl):S75.

    Article  PubMed  Google Scholar 

  5. Bekelman DB, Rumsfeld JS, Havanek EP, Yamashita TE, Hutt E, Gottlieb SH, Dy SM, Kunther JS. Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. J Gen Intern Med. 2009;24(5):592–8. doi:10.1007/s11606-009-0931-y Epub 2009 Mar 14.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Saini T, Murtagh FE, Dupont PJ, McKinnon PM, Hatfield P, Saunders Y. Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease. Palliat Med. 2006;20(6):631–6.

    Article  CAS  PubMed  Google Scholar 

  7. Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation 2010;122(3):265–72. doi:10.1161/CIRCULATIONAHA.109.933275 (Epub 2010 Jul 6).

  8. Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP. CKD in elderly patients managed without dialysis: survival, symptoms, and quality of life. CJASN. 2015;10(2):260–8. doi:10.2215/CJN.03330414.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goebel JR, Doering LV, Shugarman LR, Asch SM, Sherbourne CD, Lanto AB, Evangelista LS, Nyamathi AM, Maliski SL, Lorenz KA. Heart failure: the hidden problem of pain. J Pain Symptom Manag. 2009;38(5):698–707. doi:10.1016/j.jpainsymman.2009.04.022 (Epub 2009 Sep 3).

    Article  Google Scholar 

  10. Jorgenson A, Sidebottom AC, Richards H, Kirven J. A description of inpatient palliative care actions for patients with acute heart failure. Am J Hosp Palliat Care. 2016;33(9):863–70 (Epub 2015 Jun 30).

    Google Scholar 

  11. Chan KY, Cheng HW, Yap DY, Yip T, Li CS, Sham MK, Wong YC, Lau WK. Reduction of acute hospital admissions and improvement in outpatient attendance by intensified renal palliative care clinic follow-up: the Hong Kong experience. a description of inpatient palliative care actions for patients with acute heart failure. J Pain Symptom Manag. 2015;49(1):144–9. doi:10.1016/j.jpainsymman.2014.04.010 Epub 2014 May 23.

    Article  Google Scholar 

  12. Davidson SN, Koncicki H, Brennan F. Pain in chronic kidney disease: a scoping review. Semin Dial. 2014;27(2):188–204. doi:10.1111/sdi.12196 Epub 2014 Feb 12.

    Article  Google Scholar 

  13. Leung L. From ladder to platform: aew concept for pain management. J Prim Health Care. 2012;4(3):254–8.

    PubMed  Google Scholar 

  14. Bass JB. Dyspnea. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations, 3rd edition. Boston: Butterworths; 1990. Chapter 36. http://www.ncbi.nlm.nih.gov/books/NBK357/.

  15. Goodlin SJ. Palliative care in congestive heart failure. J Am Coll Cardiol. 2009;54(5):386–96. doi:10.1016/j.jacc.2009.02.078.

    Article  PubMed  Google Scholar 

  16. Clemens KE, Quednau I, Klaschik E. Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study. Support Care Cancer. 2009;17:367–77.

    Article  PubMed  Google Scholar 

  17. Cheng HWB, Sham MW, Chan KY, Li CS, Au HY, Yip T. Combination therapy with low-dose metolazone and furosemide: a “needless” approach in managing refractory fluid overload in elderly renal failure patients under palliative care. Int Urol Nephrol. 2014;46:180. doi:10.1007/s11255-014-0724-z9-1813.

    Article  Google Scholar 

  18. Frohlich H, Katus HA, Tager T, Lossnitzer N, Leonie G, Kihm L, Zeier M, Remppis A, Frankenstein L, Schwenger V. Peritoneal ultrafiltration in end-stage chronic heart failure. Clin Kindey J. 2015;8:219–25.

    Google Scholar 

  19. Fukuta H, Goto T, Wakami K, Ohte N. Effects exercise of drug and intervention on functional capacity and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23(1):78–85. doi:10.1177/2047487314564729 (Epub 2014 Dec 17)

  20. Cohen RS, Mubashir A, Wajahat R, Mani S, Hummel S, Maurer MS. The cardio-renal-anemia syndrom in elderly subjects with heart failure and a normal ejection fraction: a comparison with heart failure and low ejection fraction. Congest Heart Fail. 2006;12(4):186–91.

    Article  PubMed  Google Scholar 

  21. Hedayati SS, Finkelstein FO. Epidemiology, diagnosis, and management of depression in patients with CKD. Am J Kidney Dis. 2009;54(4):741–52. doi:10.1053/j.ajkd.2009.05.003.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hedayati SS, Jiang W, O’Connor CM, et al. The association between depression and chronic kidney disease and mortality among patients hospitalized with congestive heart failure. Am J Kidney Dis. 2004;44:207–15.

    Article  PubMed  Google Scholar 

  23. O’Connor CM, Jiang W, Kuchibhatla M, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (sertraline against depression and heart disease in chronic heart failure) trial. J Am Coll Cardiol. 2010;56:692–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. www.who.int/mediacenter/factsheets/fs402/en/ last updated July 2015. Accessed 12/18/15.

  25. Temel JS, Geer JA, Muzikansky A, Gallagher ER, Admane A, Jackson VA, et al. Early palliatieve care for patients with metastatic non-small-cell lung cancer. NEJM. 2010;363(8):733–42.

    Article  CAS  PubMed  Google Scholar 

  26. Mentz R, Tulsky J, Granger B, Anstrom K, Adams P, Dodson G. The palliative care in heart failure trial: rationale and design. Am Heart J. 2014;168(5):645–51.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Baumann AJ, Wheeler DO, James MJ, Turner RN, Roberta MD, Siegel A, Navarro V. Benefit of early palliative care in end stage liver disease patients awaiting transplantation. JPSM. 2015;50(6):882–6.

    Google Scholar 

  28. Hupcey JE. The state of palliative care and heart failure. Heart Lung J Acute Crit Care. 2012;41(6):529.

    Article  Google Scholar 

  29. Bakitas M, MacMartin M, Trzepkowski K, Robert A, Jackson L, Brown J, Dionne-Odom J, Kono A. Palliative care for heart failure patients: how many, when and why? J Cardiac Fail. 2013;19(3):193.

    Article  Google Scholar 

  30. Greener DT, Quill T, Amir O, Szydlowski J, Gramling RE. Palliative care referal among patients hospitalized with advanced heart failure. J Palliat Med. 2014;17(10):1115–20. doi:10.1089/jpm.2013.0658.

    Article  PubMed  Google Scholar 

  31. Gallagher R, Kimel G. Letter to the editor: palliative care for heart failure: more than is written. Can J Cardiol. 2011;27:871-e7.

    Article  PubMed  Google Scholar 

  32. Moss AH, Lunney JR, Culp S, Auber M, Kurian S, Rogers J, Dower J, Abraham J. Prognostic significance of the “surprise” question in cancer patients. J Palliat Med. 2010;13(7):837–40.

    Article  PubMed  Google Scholar 

  33. Schneider N, Oster P, Hager K, Klindtworth K. Identifying elderly heart failure patients at the end of life. Int J Cardiol. 2011;153(1):98–9. doi:10.1016/j.ijcard.2011.09.018 (Epub 2011 Oct 2)

  34. Bernacki RE, Block SD. Communication about serious illness care goals a review and synthesis of best practices. JAMA Internal Med. 2014;174(12):1994–2003. doi:10.1001/jamainternmed.2014.5271.

  35. Lemond L, Allen LA. Palliative care and hospice in advanced heart failure. Prog Cardiovasc Dis. 2011;54(2):168–78. doi:10.1016/j.pcad.2011.03.012.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Connors AF, Dawson NV, Desbiens NA, et al. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT principal investigators. JAMA. 1995;274(20):1591–8.

    Google Scholar 

  37. You J, Downar J, Fowler R, Lamontagne F, Ma I, Jayaraman D. Barriers to goals of care discussions with seriously ill hospitalized patients and their familiesa multicenter survey of clinicians. JAMA Internal Med. 2015;175(4):549–56. doi:10.1001/jamainternmed.2014.7732.

    Article  Google Scholar 

  38. Cordasco KM. Obtaining informed consent from patients: brief update review. Rockville (MD): Agency for Healthcare Research and Quality (US); Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Evidence Reports/Technology Assessments, No. 211. 2013. Chap. 39.

    Google Scholar 

  39. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251–8.

    Article  CAS  PubMed  Google Scholar 

  40. Pollock K. Is home always the best and preferred place of death? BMJ. 2015;351:4855. doi:10.1136/bmj.h4855.

  41. Holley JL. Advance care planning in ESRD/CKD: an evolving process. Clin J Am Soc Nephrol. 2012;7:1033–8. doi:10.2215/CJN.00580112.

    Article  PubMed  Google Scholar 

  42. Fagerlin A, Schneider CE. Enough: the failure of the living will. Hastings Cent Rep. 2004;34(2):30–42.

    Article  PubMed  Google Scholar 

  43. Wong SP, Kreuter W, O’Hare AM. Treatment intensity at the end of life in older adults receiving long-term dialysis. Arch Intern Med. 2012;172(8):661–3.

    Article  PubMed  Google Scholar 

  44. http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care. Accessed 15 Jan 2015.

  45. http://www.nhpco.org/history-hospice-care.

  46. Fast Fact #82 Medicare Hospice Benefit-Part I: Eligibility and Treatment Plan www.mypcnow.org.

  47. Fast Fact and concept #87 Medicare Hospice Benefit-Part II: Places of care and Funding, www.mypcnow.org.

  48. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, Mor V. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88.

    Article  CAS  PubMed  Google Scholar 

  49. Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol. 2010;28(29):4457.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Burton AM, Sautter JM, Tulsky JA, Lindquist JH, Hays JC, Olsen MK, Zimmerman SI, Steinhauser KE. Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers. J Pain Symptom Manag. 2012;44(3):410–20. doi:10.1016/j.jpainsymman.2011.09.018 (Epub 2012 Jun 22).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hesham Shaban .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Turner, R., Shaban, H. (2017). Palliation with Dual Burden of Heart and Kidney Failure: An Underutilized Strategy. In: Rangaswami, J., Lerma, E., Ronco, C. (eds) Cardio-Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-56042-7_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56042-7_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56040-3

  • Online ISBN: 978-3-319-56042-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics