The illness trajectory of end-stage renal disease dialysis patients

Chronic illness is the number one health problem in the United States. As a consequence, health care professionals have assumed an increasingly important role in helping patients and families manage illness over an extended period of time. Familiarity with the evolution of chronic illness is needed to increase the effectiveness of these efforts. The concept of a trajectory provides a way for clinicians to gain a fuller understanding of the changing nature of chronic illness. The trajectory model has not yet been used to define the experience of end-stage renal disease (ESRD). ESRD is typically viewed as the static end point of chronic renal failure. The new paradigm suggests that the experience of ESRD continues to evolve from the time of diagnosis until death and that it follows a trajectory that can be described. This article represents the first attempt to delineate the ESRD illness trajectory, including the characteristics of each phase relative to the dimensions of life. The significance of the trajectory for clinical practice is discussed as well as the need for further research to validate and refine the model.