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Physicians advocate for “more educated and deliberative decision making ... - Scope (blog) |
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More than 20 million Americans, one in 10 adults, have some form of chronic kidney disease. For those suffering from chronic kidney disease or end-stage renal disease, dialysis is a commonly recommended treatment. But a story published today in the New York Times reports that for older patients the treatment is increasingly being seen as an choice, not an imperative, and “a growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.”
Paula Span writes:
Unquestionably, dialysis has helped save lives. The mortality rate for patients with chronic kidney disease decreased 42 percent from 1995 to 2012, according to the most recent report from the United States Renal Data System.
The picture for older patients, in particular, is less rosy. About 40 percent of patients over age 75 with end-stage renal disease, or advanced kidney failure, die within a year, and only 19 percent survive beyond four years, the renal data system has reported.
…
In a Canadian survey, 61 percent of patients said they regretted starting dialysis, a decision they attributed to physicians’ and families’ wishes more than their own. In an Australian study, 105 patients approaching end-stage kidney disease said they would willingly forgo seven months of life expectancy to reduce their number of dialysis visits. They would swap 15 months for greater freedom to travel.
In real-world hospitals and nephrologists’ offices, of course, patients aren’t offered such trade-offs. “People drift into these decisions because they’re presented as the only recourse,” said Dr. V. J. Periyakoil, a geriatrician and palliative care physician at Stanford University School of Medicine.
The moving video above, which was produced by Periyakoil, tells the story of one older man’s decision to stop dialysis after 12 years. (“It takes a lot out of you – it’s a long drawn-process,” Christopher Whitney explained in the piece. “If I would get a kidney now, it would be a waste… I’m not the person I used to be.”) About the difficult decision-making process that faces patients like Whitney, Periyakoil said in an email this morning:
Persons with kidney failure often struggle with making decisions related to dialysis. These decisions impact not only the patient but also their family members. For some, these decisions have ethical and moral implications as well. You may have questions like “Should I start dialysis right away or can I wait? Is it okay to refuse dialysis? I have been on dialysis and feel tired all the time and have poor quality of life – is it okay to stop dialysis? If I stop dialysis how long will live?”
Periyakoil urges patients to “think about what your life goals are as well as what matters most to you at life’s end. Be sure to discuss these important issues with your doctor so you can make your wishes known and make decisions that are right for you and your family.”
Previously: How best to treat dialysis patients with heart disease, Keeping kidney failure patients out of the hospital, Study shows higher Medicaid coverage leads to lower kidney failure rates and Benefits of dialysis for frail elderly debated
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SS assists people with kidney disease - Maryville Daily Forum |
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Posted: Monday, March 30, 2015 3:43 pm
SS assists people with kidney disease By DANNY ZIMMERMAN maryvilledailyforum.com |
Every March, we pay special attention to the kidney, an organå vital to a healthy life.
Social Security wants to help spread the word about the importance of kidney health and about what you should do if you think you or a loved one has a kidney-related disability.
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Posted in Opinion, Columnists on Monday, March 30, 2015 3:43 pm.
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Damaged water pipe puts dialysis on hold - Times of India |
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Heart Attack Carries Worse Prognosis In Dialysis Patients - Medical Research News and Interviews on MedicalResearch.com (blog) |
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Hemodialysis
MedicalResearch.com Interview with:
Tanush Gupta, MD
Department of Medicine, Division of Cardiology
New York Medical College, NY
Medical Research: What is the background for this study? What are the main findings?
Dr.Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.
We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.
Medical Research: What should clinicians and patients take away from your report?
Dr.Gupta:: ESRD patients comprise a very sick sub-group of the overall STEMI population and are often managed sub-optimally with lower use of revascularization and proven medical therapies. In this analysis, although we observed favorable trends in the use of PCI and length of stay, there was a temporal increase in in-hospital mortality. The increasing trend in in-hospital mortality in ESRD patients with STEMI is worrisome and is in stark contrast to the trends in outcomes of STEMI in the general population, where in-hospital mortality has decreased dramatically in the modern era of reperfusion therapy.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr.Gupta:Reversal of the above mentioned adverse trends in in-hospital mortality in ESRD patients with STEMI should be the focus of future investigations.
Citation:
Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in Management and Outcomes of ST-Elevation Myocardial Infarction in Patients With End Stage Renal Disease in the United States. Am J Cardiol 2015;115:1033-1041.
MedicalResearch.com Interview with: Tanush Gupta, MD (2015). Heart Attack Carries Worse Prognosis In Dialysis Patients
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