Related Experiment Video
Updated: May 27, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Older adults with advanced chronic kidney disease and access to palliative care: Retrospective cohort study in
Helen Tam-Tham1, Giulia-Anna Perri2, Amy Freedman3
1Family physician, palliative care consulting physician, and Clinical Assistant Professor in the departments of family medicine, oncology, and community health sciences at the University of Calgary in Alberta.
Objective:
To describe the provision of primary and specialist palliative care for older adults with advanced chronic kidney disease (CKD).
Design:
Population-based retrospective descriptive cohort study using electronic health records.
Setting:
St Michael's Hospital Academic Family Health Team, including 5 clinics and an interdisciplinary home-based outreach team, in Toronto, Ont.
Participants:
Older adults who are 65 years of age or older with advanced CKD and undergoing community-based nondialysis kidney care between April 1, 2012, and April 1, 2022, with at least 1 year of follow-up.
Main Outcome Measures:
Prevalence of advance care planning, goals of care (GOC) discussions, access to specialized palliative care, frequency of hospitalizations, places of deaths, and mean survival time.
Results:
The study included 47 older adults with advanced CKD who were not undergoing dialysis and receiving primary care. Sixty-eight percent were female (n=32), and the mean (SD) age was 81 (8) years. The mean (SD) number of comorbidities was 5 (2). Almost half of the patients (n=22) lived alone. Seventy percent of the cohort (n=33) had a documented substitute decision maker. Approximately one-third of the cohort (n=16) had GOC conversations involving prognosis, hospital transfer, place of death, and treatment goals. Forty-seven percent (n=22) accessed specialist palliative care during follow-up. Seventy-four percent (n=35) had 1 or more hospitalization. Thirty-two percent (n=8) died at home. The mean (SD) survival time was 2 (2) years.
Conclusion:
A palliative approach to care including advance care planning and GOC conversations would be appropriate for older adults with advanced CKD given their high rates of comorbidities, hospitalizations, and mortality. Primary care providers might experience challenges facilitating conversations in this population, highlighting opportunities for enhanced training and point-of-care interventions, and facilitating access to specialist palliative care consultations when appropriate.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:25Continuing Care
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...