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An aging renal population-is dialysis always the answer?
1City University, London, UK.
British Journal of Nursing (Mark Allen Publishing)
|June 8, 2011
Summary
For individuals with stage 5 chronic kidney disease (CKD), treatment options include dialysis, transplantation, or conservative management. Supportive care may be a more suitable option for frail patients with multiple comorbidities.
Area of Science:
- Nephrology
- Geriatrics
- Palliative Care
Background:
- Aging populations are experiencing increased prevalence of comorbid conditions, notably chronic kidney disease (CKD).
- Stage 5 CKD presents complex treatment decisions for patients and clinicians.
- Historically, refusal of life-prolonging treatments like dialysis was stigmatized.
Purpose of the Study:
- To discuss treatment options for stage 5 CKD.
- To highlight the complexities and limitations of dialysis.
- To recognize the value of conservative management and supportive care.
Main Methods:
- Literature review and discussion of current treatment modalities for stage 5 CKD.
- Analysis of the role of dialysis (hemodialysis and peritoneal dialysis) and transplantation.
- Exploration of conservative management (supportive care) as an alternative.
Main Results:
- Dialysis substitutes kidney function but does not restore it and can be arduous, potentially shortening life.
- Conservative management offers an alternative for patients unsuitable for dialysis.
- Patient needs and experiences regarding dialysis refusal are increasingly acknowledged.
Conclusions:
- Treatment decisions for stage 5 CKD must consider individual patient factors, including frailty and comorbidities.
- Supportive and palliative care can be appropriate and beneficial for some patients.
- A nuanced understanding of patient preferences and quality of life is crucial in end-of-life care for CKD patients.
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