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Abstract
Introduction: Conservative treatment is a treatment option in chronic kidney disease. The election of this treatment is determined by patient and / or the family. Objective: The objective of the study was to analyze the process of choosing conservative treatment, identify the patient profile, the patient’ survival and who communicate the election. Material and Método: Observational, retrospective study. Patients who chose conservative treatment between 2010-2017 were included. The data were obtained from nursing records in clinical history. Demographic variables, survival, Charlson Comorbidity Index, Barthel Index and patient values were collected using the Values Cards tool. Resultados: The sample was 95 patients, 41.05% men, mean age 82.36±9 years, 27.37% institutionalized. The family reported the choice in 62.11% of the cases. The mean glomerular filtration rate at the beginning of the information was 11.53±2.73 ml / min, the median of Charlson index: 8 (13-3), median of Barthel index: 55 (100-0) points. In the process of contrasting values, the most chosen card was “health personnel responsible for treatment”. The median survival was 496.19±553.8 days. Men and the institutionalized live less, without significant difference. The risk of death is greater, as the Charlson index increases and the glomerular filtration rate decreases (p=0.01). The family announced the election to continue conservative treatment in 62.11% of cases.
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References
- Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Nefrología 2014;34(2):243-62.
- Martínez-Ocaña JC. Gestión de la enfermedad renal crónica avanzada. Dial Traspl 2011;32(4):165-7.
- Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE» núm. 274, de 15 de noviembre de 2002:40126-32.
- Ministerio de Sanidad, Servicios Sociales e Igualdad. Compromiso por la calidad de las Sociedades Científicas en España. [Acceso 25 julio 2018] Disponible en: http://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htm
- Ladin K, Weiner DE. Better informing older patients with kidney failure in an era of patient-centered care. Am J Kidney Dis. 2015;65(3):372-74.
- Combs SA, Davison SN. Palliative and end-of-life care issues in chronic kidney disease. Curr Opin Support Palliat Care. 2015;9(1):14-9.
- Prieto-Velasco M, Quiros P, Remon C; Spanish Group for the Implementation of a Shared Decision Making Process for RRT Choice with Patient Decision Aid Tools. The Concordance between Patients’ Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia? PLoS One. 2015 Oct 14;10(10):e0138811.
- Tejedor A, De las Cuevas X. Cuidado paliativo en el paciente con enfermedad renal crónica avanzada (Grado 5), no susceptible de tratamiento dialítico. Nefrologia 2008;(Supl 3):S129-36.
- Andreu L, Hidalgo MA, Moreno C. Tratamiento conservador ante la Enfermedad Renal Crónica. Enferm Nefrol 2015;18 (4):303-7.
- Teruel JL, Burguera V, Gomis A, Rivera M, Fernández-Lucas M, Rodríguez N et al. Elección de tratamiento conservador en la enfermedad renal crónica. Nefrología 2015;35(3):273-9.
- O’Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-35.
- Chandna SM, da Silva-Gane, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: Comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608-14.
- Murtagh FE, Burns A, Moranne O, Morton RL, Naicker S. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease. Clin J Am Soc Nephrol. 2016;11(10):1909-14.
- Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002-9.
- Morton RL, Turner RM, Howard K, Snelling P, Webster AC. Patients who plan for conservative care rather than dialysis: A National Observational Study in Australia. Am J Kidney Dis.2012;59(3):419–27.
- Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Choosing not to dialyse: Evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron. 2003;95(2):40-6.
- Morton R L, Tong A, Howard K, Snelling P, Webster A C. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ 2010; 340:c112.
- Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, Finkelstein FO. Patients’ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 2002; 22(2):184-90.
- Low J, Smith G, Burns A, Jones L. The impact of end-stage kidney disease (ESKD) on close persons: a literature review. NDT plus 2008;1(2):67-79.
- Leiva JP, Sánchez R, García H, Fernández MJ, Heras M, Molina A et al. Cuidados de soporte renal y cuidados paliativos. Nefrologia 2012;32(1):20-7.
- Noble H, Kelly D, Hudson P. Experiences of carers supporting dying renal patients managed without dialysis. J Adv Nurs. 2013;69(8):1829-39.
- Aguilera AI, Linares B, Alonso AC, Prieto M. Análisis del impacto de los valores personales en la elección del Tratamiento Sustitutivo Renal. Enferm Nefrol 2017;20(3):209-14.
- Morton RL, Devitt J, Howard K, Anderson K, Snelling P, Cass A. Patient views about treatment of stage 5 CKD: a qualitative analysis of semistructured interviews. Am J Kidney Dis. 2010;55(3):431-40.
- Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant. 2007;22(7):1955-62.
- Ellam T, El-Kossi M, Prasanth KC, El-Nahas M, Khwaja A. Conservatively managed patients with stage 5 chronic kidney disease– outcomes from a single center experience. QJM. 2009;102(8):547-54.
References
Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Nefrología 2014;34(2):243-62.
Martínez-Ocaña JC. Gestión de la enfermedad renal crónica avanzada. Dial Traspl 2011;32(4):165-7.
Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE» núm. 274, de 15 de noviembre de 2002:40126-32.
Ministerio de Sanidad, Servicios Sociales e Igualdad. Compromiso por la calidad de las Sociedades Científicas en España. [Acceso 25 julio 2018] Disponible en: http://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htm
Ladin K, Weiner DE. Better informing older patients with kidney failure in an era of patient-centered care. Am J Kidney Dis. 2015;65(3):372-74.
Combs SA, Davison SN. Palliative and end-of-life care issues in chronic kidney disease. Curr Opin Support Palliat Care. 2015;9(1):14-9.
Prieto-Velasco M, Quiros P, Remon C; Spanish Group for the Implementation of a Shared Decision Making Process for RRT Choice with Patient Decision Aid Tools. The Concordance between Patients’ Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia? PLoS One. 2015 Oct 14;10(10):e0138811.
Tejedor A, De las Cuevas X. Cuidado paliativo en el paciente con enfermedad renal crónica avanzada (Grado 5), no susceptible de tratamiento dialítico. Nefrologia 2008;(Supl 3):S129-36.
Andreu L, Hidalgo MA, Moreno C. Tratamiento conservador ante la Enfermedad Renal Crónica. Enferm Nefrol 2015;18 (4):303-7.
Teruel JL, Burguera V, Gomis A, Rivera M, Fernández-Lucas M, Rodríguez N et al. Elección de tratamiento conservador en la enfermedad renal crónica. Nefrología 2015;35(3):273-9.
O’Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-35.
Chandna SM, da Silva-Gane, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: Comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608-14.
Murtagh FE, Burns A, Moranne O, Morton RL, Naicker S. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease. Clin J Am Soc Nephrol. 2016;11(10):1909-14.
Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002-9.
Morton RL, Turner RM, Howard K, Snelling P, Webster AC. Patients who plan for conservative care rather than dialysis: A National Observational Study in Australia. Am J Kidney Dis.2012;59(3):419–27.
Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Choosing not to dialyse: Evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron. 2003;95(2):40-6.
Morton R L, Tong A, Howard K, Snelling P, Webster A C. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ 2010; 340:c112.
Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, Finkelstein FO. Patients’ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 2002; 22(2):184-90.
Low J, Smith G, Burns A, Jones L. The impact of end-stage kidney disease (ESKD) on close persons: a literature review. NDT plus 2008;1(2):67-79.
Leiva JP, Sánchez R, García H, Fernández MJ, Heras M, Molina A et al. Cuidados de soporte renal y cuidados paliativos. Nefrologia 2012;32(1):20-7.
Noble H, Kelly D, Hudson P. Experiences of carers supporting dying renal patients managed without dialysis. J Adv Nurs. 2013;69(8):1829-39.
Aguilera AI, Linares B, Alonso AC, Prieto M. Análisis del impacto de los valores personales en la elección del Tratamiento Sustitutivo Renal. Enferm Nefrol 2017;20(3):209-14.
Morton RL, Devitt J, Howard K, Anderson K, Snelling P, Cass A. Patient views about treatment of stage 5 CKD: a qualitative analysis of semistructured interviews. Am J Kidney Dis. 2010;55(3):431-40.
Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant. 2007;22(7):1955-62.
Ellam T, El-Kossi M, Prasanth KC, El-Nahas M, Khwaja A. Conservatively managed patients with stage 5 chronic kidney disease– outcomes from a single center experience. QJM. 2009;102(8):547-54.