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Palliative Care in CKD Patients

Palliative Care in CKD Patients. Peenida Skulratanasak Division of Nephrology, Siriraj hospital. Therapeutic Options in CKD. Prevalence of Dialysis Patients. > 65 yr -- 39% > 75 yr -- 17%. Mortality in Dialysis Patients. 2015 USRDS Annual Data Report. Survival of Dialysis Patients.

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Palliative Care in CKD Patients

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  1. Palliative Care in CKD Patients Peenida Skulratanasak Division of Nephrology, Siriraj hospital

  2. Therapeutic Options in CKD

  3. Prevalence of Dialysis Patients > 65 yr -- 39% > 75 yr -- 17%

  4. Mortality in Dialysis Patients 2015 USRDS Annual Data Report

  5. Survival of Dialysis Patients • Geriatric syndrome • Dementia • Functional disability • Malnutrition • Depression ANZDATA, Nephrol Dial Transplant (2012) 0: 1–7

  6. Therapeutic Options in CKD

  7. Survival between CM and RRT • CKD stage 5 • eGFR <15 ml/min/1.73m2 • 18-year period to August 2008 21.2 vs 67.1 mo. P<0.001 Nephrol Dial Transplant (2011) 26: 1608–1614

  8. Survival between CM and RRT • >75 years — CM vs RRT adjusted for age, gender, ethnicity, the presence of diabetes and the presence of high comorbidity • Median survival in RRT patients is better by ~4 months, (P = 0.43) Nephrol Dial Transplant (2011) 26: 1608–1614

  9. Prognostic Tools for Elderly • Hemodialysis Mortality Predictor • Touchcalc • Charlson Comorbidity Index • Karnofsky Performance Status • WHO Performance Status

  10. Clin J Am SocNephrol5: 72–79, 2010.

  11. HD Mortality Predictor http://touchcalc.com/calculators/sq Clin J Am Soc Nephrol 2010;5:72-9

  12. Charlson Comorbidity Index (CCI) Prognosis from CCI

  13. Charlson Comorbidity Index (CCI) • Female 75 years old with underlying disease • DM with diabetic nephropathy • Chronic kidney disease • History of CVA Age – 3 points DM – 2 points CKD – 2 points CVA – 1 point CCI – 8 points

  14. Karnofsky Performance Status

  15. WHO performance

  16. Survival between CM and RRT • Pt >70 years • eGFR <20 ml/min/1.73m2 2.2 vs 4.6 yr. p <0.0001 Palliative Medicine 27(9) 829–839, 2013.

  17. Survival between CM and RRT • But NS in older age (>80 yr), with higher CCI score (>8) and poorer WHO performance scores (>3) Palliative Medicine 27(9) 829–839, 2013.

  18. Optimize QoL • Avoid unnecessary hospitalizations • Hospital-free day • Control symptoms • A prospective study from the UK • Conservative management • Patient survival of 1.95 years, with a 1year survival rate of 65% • 60% of these patients did not have any hospital admissions over the 3-year follow-up Ren. Fail.29(6),653–659 (2007)

  19. Quality of life assessment • SF-36 mental health and physical health • HADS: Hospital anxiety and depression scale • SWLS: Satisfaction with life scale Clin J Am SocNephrol 7: 2002–2009, 2012.

  20. Multilevel growth models demonstrated noserial change in quality-of-life measures • Starting dialysis led to a significant decrease in the SWLS score Clin J Am SocNephrol 7: 2002–2009, 2012.

  21. Comorbidities Performance status Age Survival Quality of life Hospitalization

  22. Elderly Population in the Future Elderly people 30%  21 million people Present – Dialysis pt. 1,200 pmp In 2574 – Predicted dialysis pt. 3,325 pmp -- Predicted elderly dialysis pt. 1,330 pmp สำนักงานคณะกรรมการพัฒนาเศรษฐกิจและสังคมแห่งชาติ

  23. Prevalence of Dialysis Patients

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