Materiały źródłowe

• #1 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. […] Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. […] End-stage renal disease is defined as a GFR of less than 15 mL/min. […] Many chronic diseases can cause end-stage renal disease. In many developed and developing countries, diabetes mellitus is the leading cause. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation.

• #2 End-stage renal disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538

  During a kidney biopsy, your doctor uses a needle to remove a small sample of kidney tissue for lab testing. […] To diagnose end-stage renal disease, your health care provider may ask you about your family’s and your medical history. […] When your kidneys no longer work at a level that’s necessary to keep you alive, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 15% of typical kidney function. […] Our caring team of Mayo Clinic experts can help you with your end-stage renal disease-related health concerns. […] End-stage renal disease treatments include: Kidney transplant, Dialysis, Supportive care. […] A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis. […] Dialysis does some of the work of your kidneys when your kidneys can’t do it themselves.

• #3 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Chronic kidney disease (CKD) is a progressive syndrome in which the kidneys lose their ability to filter blood, concentrate urine, excrete waste products, and maintain electrolyte balance. End-stage renal disease (ESRD) is the end result of many forms of CKD. It is characterized by severely limited kidney function that is insufficient to maintain life. Thus, most patients with ESRD require renal replacement therapy via hemodialysis, peritoneal dialysis, or kidney transplantation. […] Life expectancy for ESRD patients has improved since the advent of dialysis in the 1960s, especially with the introduction of renal transplantation. Five-year survival ranges from 25-98%, depending on risk factors. […] ESRD is defined by a GFR that is less than 15 mL/min/1.73 m2. […] In general, once CKD has degenerated to ESRD, it is irreversible. Treatment is aimed at treating complications and replacing renal function via dialysis or transplantation.

• #4 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. […] Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. […] End-stage renal disease is defined as a GFR of less than 15 mL/min. […] Many chronic diseases can cause end-stage renal disease. In many developed and developing countries, diabetes mellitus is the leading cause. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation.

• #5 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. […] Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. […] End-stage renal disease is defined as a GFR of less than 15 mL/min. […] Many chronic diseases can cause end-stage renal disease. In many developed and developing countries, diabetes mellitus is the leading cause. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation.

• #6 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  More than 500,000 people in the United States live with end-stage renal disease (ESRD). […] The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. […] Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. […] End-stage renal disease is defined as a GFR of less than 15 mL/min. […] Many chronic diseases can cause end-stage renal disease. In many developed and developing countries, diabetes mellitus is the leading cause. […] Treatment of end-stage renal disease involves correcting parameters at the level of the patient’s presentation.

• #7 Chronic Renal Failure Nursing Care and Management: Study Guide

  https://nurseslabs.com/chronic-renal-failure/

  Learn about the nursing care management of patients with chronic renal failure in this nursing study guide. […] The patient with ESRD requires astute nursing care to avoid the complications of reduced renal function and the stresses and anxieties of dealing with a life-threatening illness. […] Assessment of a patient with ESRD includes the following: Assess fluid status (daily weight, intake and output, skin turgor, distention of neck veins, vital signs, and respiratory effort). […] Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed: Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water. […] The goals for a patient with chronic renal failure include: Maintenance of ideal body weight without excess fluid.

• #8 Through the Patients’ Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care

  https://www.mdpi.com/2227-9032/5/3/36

  Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient’s quality of life. […] The objectives of care for patients on hemodialysis include providing sufficient dialysis, maintaining vascular access, ensuring adequate nutrition, minimizing hospitalization, and prolonging life and its quality. Nursing care, on the other hand, involves interactive actions built on the ethical dimension between the caregiver and the client. […] According to Kimmel, hemodialysis is a lifelong treatment that significantly and sometimes adversely affects patients’ physical and mental abilities, with depression, anxiety and fatigue being common issues.

• #9 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  End-stage renal disease is irreversible and has no cure. Nursing care priorities for patients with end-stage renal disease include: […] Assist in kidney transplantation or dialysis […] Instruct on the management of chronic conditions […] Implement fluid restrictions and diet recommendations […] Promote physical and psychosocial well-being […] Enhance the patients overall quality of life […] Instruct on lifestyle modifications […] Provide support to the patient and family […] Collaborate with the nephrologist and other team members. […] Nursing interventions and care are essential for the patients recovery. […] Encourage treatment adherence. […] When the kidneys no longer function on their own, dialysis is required to filter the blood and remove toxins. […] Educate the patient about their prognosis and treatment options.

• #10 11 Chronic Renal Failure Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/chronic-renal-failure-nursing-care-plans/

  The following are the nursing priorities for patients with chronic kidney disease (CKD): Management of fluid and electrolyte balance, Blood pressure control, Monitoring and management of renal function, Medication administration and compliance, Dietary modifications and nutritional support, Assessment and management of complications (e.g., anemia, cardiovascular disease), Education on self-care and lifestyle modifications, Regular assessment and management of comorbidities (e.g., diabetes, hypertension). […] Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with chronic kidney disease (CKD) based on the nurses clinical judgement and understanding of the patients unique health condition. […] Goals and expected outcomes may include: The client will maintain cardiac output as evidenced by BP and heart rate within the clients normal range; peripheral pulses are strong and equal with prompt capillary refill time. The client will experience no signs/symptoms of bleeding/hemorrhage. The client will maintain/demonstrate improvement in laboratory values. The client will not experience injury as evidenced by maintenance of normal BP, hemoglobin, and hematocrit levels (specify lower limit). The client denies bone pain or sensory loss. The client will regain/maintain an optimal level of mentation. The client will identify ways to compensate for cognitive impairment/memory deficits. The client will maintain intact skin. The client will demonstrate behaviors/techniques to prevent skin breakdown/injury. The client will maintain the integrity of mucous membranes. The client will identify/initiate specific interventions to promote healthy oral mucosa. The client will verbalize understanding of the condition/disease process, therapeutic needs, and potential complications. The client will correctly perform the necessary procedures and explain the reasons for the actions. The client will demonstrate/initiate necessary lifestyle changes. The client and family members will identify positive coping mechanisms. The client and family members will begin to work through the grief process. The client will display a continuous flow of urine with adequate output for the individual situation. The client will demonstrate behaviors to regain bladder and urinary control. The client will empty their bladder regularly and completely.

• #11 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  End-stage renal disease is irreversible and has no cure. Nursing care priorities for patients with end-stage renal disease include: […] Assist in kidney transplantation or dialysis […] Instruct on the management of chronic conditions […] Implement fluid restrictions and diet recommendations […] Promote physical and psychosocial well-being […] Enhance the patients overall quality of life […] Instruct on lifestyle modifications […] Provide support to the patient and family […] Collaborate with the nephrologist and other team members. […] Nursing interventions and care are essential for the patients recovery. […] Encourage treatment adherence. […] When the kidneys no longer function on their own, dialysis is required to filter the blood and remove toxins. […] Educate the patient about their prognosis and treatment options.

• #12 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Discuss vascular access options. […] Instruct on peritoneal dialysis. […] Prepare for a kidney transplant. […] Discuss palliative and end-of-life care. […] Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes. […] Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia). […] Imbalanced nutrition related to end-stage renal disease can be caused by disease process, chronic inflammation, uremic toxins, metabolic acidosis, and food aversion.

• #13 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Impaired urinary elimination related to end-stage renal disease can be caused by loss of kidney function to filter and eliminate toxic wastes from the body through urine. […] Ineffective tissue perfusion related to end-stage renal disease can be caused by compromised kidney function, hypervolemia, hypertension, nephrotoxic medications, and uncontrolled diabetes.

• #14 Chronic Renal Failure Nursing Care and Management: Study Guide

  https://nurseslabs.com/chronic-renal-failure/

  Learn about the nursing care management of patients with chronic renal failure in this nursing study guide. […] The patient with ESRD requires astute nursing care to avoid the complications of reduced renal function and the stresses and anxieties of dealing with a life-threatening illness. […] Assessment of a patient with ESRD includes the following: Assess fluid status (daily weight, intake and output, skin turgor, distention of neck veins, vital signs, and respiratory effort). […] Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed: Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water. […] The goals for a patient with chronic renal failure include: Maintenance of ideal body weight without excess fluid.

• #15 Home Health Careplan for End Stage Renal Failure (ESRD)

  https://go.myhomecarebiz.com/blog/nursing-care-plan-for-renal-failure

  For the patient with end stage renal failure (ESRD), in addition to assessing Urinary Incontinence M1610 and Shortness of breath on M1400, also include these MyHomecareBiz Best Practice assessment strategies and and our nursing care plan for ESRD. […] Best Practice Assessment Strategies for Renal Failure […] Monitor vital signs […] Review laboratory tests for changes in renal function: potassium, sodium, calcium, magnesium, BUN and creatinine […] Measure urine output on a regular schedule and weigh daily […] Observe for signs of infection […] Monitor level of consciousness and behavior.

• #16 Chronic Kidney Disease (CKD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/chronic-kidney-disease-nursing-diagnosis-care-plan/

  As the kidneys further deteriorate and lose their ability to filter out toxins, other organ systems become affected, and irreversible damage may occur. The final stage of CKD is end-stage renal disease (ESRD), which requires dialysis and kidney transplant. […] The preservation of existing kidney function, reduction of cardiovascular disease risks, prevention of complications, and promotion of the patients comfort are the primary goals of CKD management and treatment. […] Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with chronic kidney disease. […] Patients with CKD who experience serious complications like metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable fluid retention, and malnutrition will need renal replacement therapy.

• #17 11 Chronic Renal Failure Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/chronic-renal-failure-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with chronic kidney disease (CKD) may include: Managing Decrease in Cardiac Output, Promoting Infection Control and Minimizing Risk of Infection, Managing Cognitive Symptoms, Providing Skin Care and Maintaining Skin Integrity, Promoting Oral Health, Initiating Health Teachings and Patient Education, Reducing Anxiety and Providing Emotional Support, Promoting Safety and Preventing Injury Risk, Managing Effective Urinary Elimination, Administering Medications and Pharmacological Support, Assessing and Monitoring for Potential Complications, Monitoring Laboratory and Diagnostic Procedures.

• #18 Chronic Renal Failure Nursing Care and Management: Study Guide

  https://nurseslabs.com/chronic-renal-failure/

  Nursing care is directed toward the following: Fluid status. Assess fluid status and identify potential sources of imbalance. […] The nurse should promote home and self-care to increase the esteem of the patient. […] The documentation of a patient with chronic renal failure should focus on the following: Existing conditions contribute to and degree of fluid retention.

• #19 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Volume derangements Hypervolemia is common in ESRD, depending on patients’ residual renal function, diet, and use of diuretics. The management of volume overload which goes hand in hand with monitoring for renal function and metabolic abnormalities, is contingent on the patient’s estimated prognosis. The goal of preserving fluid balance is to manage symptoms such as dyspnea, cramping and debility while minimizing electrolyte derangements. For patients expected to have a more protracted survival, aggressive diuresis with sequential nephron blockade using thiazide diuretics (like metolazone) and aldosterone antagonists (like spironolactone) can be offered (17) while obtaining occasional lab draws. For patients with a shorter life expectancy who do not wish to pursue additional workup, maintenance with a loop diuretic as a single agent is appropriate. In general, oral loop diuretics can be continued in CM if this has been maintaining urine output. Subcutaneous (SQ) or intravenous (IV) furosemide can be used for urgent situations as its onset of action is within 30 minutes. If converting to a parenteral route, divide the oral dose by half; IV and SQ are dosed equally. Keep in mind that patients with advanced CKD often need very high doses to achieve diuresis and in ESRD doses of 80-160 mg IV furosemide at a time are often needed (18). See Fast Fact #353.

• #20 Chronic Kidney Disease (CKD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/chronic-kidney-disease-nursing-diagnosis-care-plan/

  As the kidneys further deteriorate and lose their ability to filter out toxins, other organ systems become affected, and irreversible damage may occur. The final stage of CKD is end-stage renal disease (ESRD), which requires dialysis and kidney transplant. […] The preservation of existing kidney function, reduction of cardiovascular disease risks, prevention of complications, and promotion of the patients comfort are the primary goals of CKD management and treatment. […] Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with chronic kidney disease. […] Patients with CKD who experience serious complications like metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable fluid retention, and malnutrition will need renal replacement therapy.

• #21 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Discuss vascular access options. […] Instruct on peritoneal dialysis. […] Prepare for a kidney transplant. […] Discuss palliative and end-of-life care. […] Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes. […] Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia). […] Imbalanced nutrition related to end-stage renal disease can be caused by disease process, chronic inflammation, uremic toxins, metabolic acidosis, and food aversion.

• #22 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Discuss vascular access options. […] Instruct on peritoneal dialysis. […] Prepare for a kidney transplant. […] Discuss palliative and end-of-life care. […] Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes. […] Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia). […] Imbalanced nutrition related to end-stage renal disease can be caused by disease process, chronic inflammation, uremic toxins, metabolic acidosis, and food aversion.

• #23 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Discuss vascular access options. […] Instruct on peritoneal dialysis. […] Prepare for a kidney transplant. […] Discuss palliative and end-of-life care. […] Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes. […] Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia). […] Imbalanced nutrition related to end-stage renal disease can be caused by disease process, chronic inflammation, uremic toxins, metabolic acidosis, and food aversion.

• #24 Chronic Kidney Disease (CKD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/chronic-kidney-disease-nursing-diagnosis-care-plan/

  Patients with stage 5 renal failure will require dialysis. Dialysis nurses are trained to provide hemodialysis or peritoneal dialysis. […] Dialysis is often indicated for patients with end-stage CKD as this can help reduce and eliminate uremic toxins, correct electrolyte imbalances, control fluid status, and prevent complications, including decreased cardiac output, hypertension, and pericardial effusion.

• #25 Chronic Kidney Disease (CKD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/chronic-kidney-disease-nursing-diagnosis-care-plan/

  Patients with stage 5 renal failure will require dialysis. Dialysis nurses are trained to provide hemodialysis or peritoneal dialysis. […] Dialysis is often indicated for patients with end-stage CKD as this can help reduce and eliminate uremic toxins, correct electrolyte imbalances, control fluid status, and prevent complications, including decreased cardiac output, hypertension, and pericardial effusion.

• #26 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Clinicians must be aware of the many medical complications associated with ESRD. […] Early nephrology referral for patients at increased risk of ESRD is vital because it is associated with improved patient-centered outcomes, including mortality. […] Goals of early referral include initiating disease-specific therapies; slowing the progression of chronic kidney disease; evaluating and treating comorbid conditions and complications; providing psychosocial support; and planning for kidney transplantation, dialysis, or conservative kidney management. […] A key consideration for patients with ESRD is establishing eligibility for kidney transplantation, which, compared with dialysis or conservative management, improves survival and quality of life. […] Most patients elect to receive dialysis to treat their ESRD, and these patients tend to live longer than those choosing conservative management.

• #27 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient’s renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

• #28 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient’s renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

• #29 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient’s renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

• #30 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient’s renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

• #31 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Itchiness Chronic kidney disease (CKD)-associated pruritus is a common and distressing symptom (5, 6) (See Fast Fact # 37). Except for gabapentin, which has been studied in variable doses from 100 mg daily to 400 mg twice weekly in a few trials (7), well-controlled evidence for other effective treatments is lacking. Immunomodulating treatments such as topical tacrolimus (8), ultraviolet light B phototherapy (9), and opioid receptor antagonists have documented efficacy (10). New kappa-opioid receptor antagonists that do not cross the blood brain barrier are being studied with promising clinical results (11). […] Dyspnea See Fast Fact #27. Optimize volume status and anemia and address any underlying anxiety. […] Pain Systemic NSAIDs are not recommended but topical NSAIDs have been shown to be effective in musculoskeletal syndromes. Opioids that are safer in renal insufficiency include (12): fentanyl, methadone, and buprenorphine. Hydromorphone is commonly used, but the neuroexcitatory effect of its metabolite is often overlooked. For patients with calciphylaxis (see Fast Fact #325), ketamine (13) and topical morphine (14) have been investigated. For the latter, a morphine 0.125% gel mixture (morphine sulfate 10 mg in 8 g of sterile gel) has been recommended up to three times daily (15); however, the systemic bioavailability of topical morphine seems to be low (16). See Fast Facts #161 and 325.

• #32 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  GI symptoms Renally-dosed haloperidol is a prudent initial step for nausea management, as it may improve other terminal symptoms in patients with ESRD such as agitation (19). Ondansetron and metoclopramide can be considered as well. The diet should be liberalized, despite metabolic concerns. Dysgeusia and anorexia should be assessed regularly. See Fast Facts # 100, 304, and 314 […] Pharmacologic considerations Other interventions that can address electrolyte or acid-base derangements which can potentially cause distressing pain, cramping, or weakness should be discussed with the patient. These include therapies for hyperkalemia, acidemia, and mineral bone disease. Stopping blood pressure medications such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACE/ARB) is recommended as tight blood pressure control only conveys long-term benefits and elevated blood pressure is rarely symptomatic. ACE/ARBs also pose risks of hyperkalemia and symptomatic hypotension complicated by dizziness and falls.

• #33 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Shared decision-making should be used, with adequate time for patients to consider the various dialysis modalities and the option of conservative management. […] Most patients with ESRD will be treated with hemodialysis, and arteriovenous access (fistula or graft) is usually preferred. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] People with ESRD are at high risk of developing protein-energy wasting and other malnutrition disorders and should receive nutritional counseling from a registered dietitian. […] Most patients receiving dialysis have hypertension.

• #34

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12424

  End-stage renal (or kidney) disease happens when your kidneys can no longer do their jobs. They can’t remove waste from your blood. And they aren’t able to balance your body’s fluids and chemicals. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you have any problems with your medicine. Make sure your doctor knows all of the medicines and natural health products you take. […] Follow a diet plan that is easy on your kidneys. A dietitian can help you create an eating plan with the right amounts of salt (sodium), potassium, and protein. You may also need to limit how much fluid you drink each day. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any problems.

• #35 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  People on dialysis will need to make sure they have the right amounts of protein and certain minerals. […] Nutrition and eating healthy are important parts of your health. […] A dietitian can make recommendations and help you with any changes in the foods you eat. […] Exercise and physical activity, along with nutrition, are important parts of your health.

• #36 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  People on dialysis will need to make sure they have the right amounts of protein and certain minerals. […] Nutrition and eating healthy are important parts of your health. […] A dietitian can make recommendations and help you with any changes in the foods you eat. […] Exercise and physical activity, along with nutrition, are important parts of your health.

• #37 11 Chronic Renal Failure Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/chronic-renal-failure-nursing-care-plans/

  Use this nursing care plan and management guide to help care for patients with chronic renal failure. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for chronic renal failure in this guide. […] The nursing care planning goals for patients with chronic renal failure include monitoring and managing fluid and electrolyte imbalances, preventing complications such as infection and hypertension, providing dietary counseling, and coordinating with other healthcare professionals to optimize the patients overall care and promoting self-care and compliance to treatment regimens to delay the progression of the disease and improve the quality of life for the patient. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

• #38 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. […] Every patient with end-stage renal disease should be timely referred for renal transplantation. […] The management of end-stage renal disease requires a dedicated interprofessional healthcare team comprised of the following: Nephrologist, Intensivist, Renal transplant surgeon, Nurse educator, Pharmacist, Nutritionist. […] The specialized nurse educator plays a vital role in educating the patient about lifestyle modifications necessary to prevent the progression of CKD. […] The pharmacist should identify those patients who carry a diagnosis of CKD and provide specialized instructions to these patients, particularly concerning avoiding nephrotoxic agents and medications.

• #39 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Kidney transplantation is the treatment of choice for appropriate candidates, and it requires considerable preparation and planning. […] Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] It is essential to treat ESRD complications that may arise. […] Psychiatric disorders are common in the context of kidney disease and can interfere with treatment. […] Exercise should be encouraged in ESRD patients. […] Compared with the general population, patients with ESRD have significantly worse outcomes after cardiac arrest.

• #40 Through the Patients’ Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care

  https://www.mdpi.com/2227-9032/5/3/36

  For hemodialysis patients who spend a considerable portion of their life receiving treatment, nursing care is of pivotal importance, and the identification of the bottlenecks hampering nursing care would contribute to an ameliorated relationship between nephrology nurses and patients and inevitably, to a better quality of life for the latter. […] The nursing care offered on hemodialysis patients entails unique characteristics in relation to other nursing plans. […] In Greece, the nursing care provided to ESRD patients is of particular importance due to the large proportion of patients suffering from chronic renal failure and the great number of those on hemodialysis. […] The rendered care involved personal dignity, nurses’ technical skills and safe practices, and the maintenance of a responsive environment. Hemodialysis patients in particular require constant physical and emotional support.

• #41 Through the Patients’ Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care

  https://www.mdpi.com/2227-9032/5/3/36

  The need to support patients psychologically has been highlighted in recent publications. […] According to a qualitative descriptive phenomenological study conducted among 14 nurses at two distinct hemodialysis centers in Korea, nurses are not psychologically and emotionally inactive while providing care. […] The current qualitative analysis of the experiences of CKD patients could potentially facilitate our understanding of how specific characteristics and competences of nephrology nurses have a direct impact on the quality of the provided health care.

• #42 11 Chronic Renal Failure Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/chronic-renal-failure-nursing-care-plans/

  Use this nursing care plan and management guide to help care for patients with chronic renal failure. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for chronic renal failure in this guide. […] The nursing care planning goals for patients with chronic renal failure include monitoring and managing fluid and electrolyte imbalances, preventing complications such as infection and hypertension, providing dietary counseling, and coordinating with other healthcare professionals to optimize the patients overall care and promoting self-care and compliance to treatment regimens to delay the progression of the disease and improve the quality of life for the patient. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

• #43 Kidney failure (ESRD) – Symptoms, stages, & treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/kidney-failure

  People on dialysis will need to make sure they have the right amounts of protein and certain minerals. […] Nutrition and eating healthy are important parts of your health. […] A dietitian can make recommendations and help you with any changes in the foods you eat. […] Exercise and physical activity, along with nutrition, are important parts of your health.

• #44 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Kidney transplantation is the treatment of choice for appropriate candidates, and it requires considerable preparation and planning. […] Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] It is essential to treat ESRD complications that may arise. […] Psychiatric disorders are common in the context of kidney disease and can interfere with treatment. […] Exercise should be encouraged in ESRD patients. […] Compared with the general population, patients with ESRD have significantly worse outcomes after cardiac arrest.

• #45 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. […] Every patient with end-stage renal disease should be timely referred for renal transplantation. […] The management of end-stage renal disease requires a dedicated interprofessional healthcare team comprised of the following: Nephrologist, Intensivist, Renal transplant surgeon, Nurse educator, Pharmacist, Nutritionist. […] The specialized nurse educator plays a vital role in educating the patient about lifestyle modifications necessary to prevent the progression of CKD. […] The pharmacist should identify those patients who carry a diagnosis of CKD and provide specialized instructions to these patients, particularly concerning avoiding nephrotoxic agents and medications.

• #46 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  For uremic manifestations, long-term renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplantation) is needed. […] Early patient education should be initiated regarding natural disease progression, different modalities for dialysis, and renal transplantation. […] Every patient with end-stage renal disease should be timely referred for renal transplantation. […] The management of end-stage renal disease requires a dedicated interprofessional healthcare team comprised of the following: Nephrologist, Intensivist, Renal transplant surgeon, Nurse educator, Pharmacist, Nutritionist. […] The specialized nurse educator plays a vital role in educating the patient about lifestyle modifications necessary to prevent the progression of CKD. […] The pharmacist should identify those patients who carry a diagnosis of CKD and provide specialized instructions to these patients, particularly concerning avoiding nephrotoxic agents and medications.

• #47 End-Stage Renal Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499861/

  A trained nutritionist should also be involved in the care of these patients to guide an appropriate diet plan specific to their needs. […] To improve outcomes, each interprofessional team member should maintain accurate and updated patient records, communicate with the other team members, and act collaboratively to ensure that the patient receives optimal care resulting in the best outcomes.

• #48 End-stage kidney disease: The last 12 months

  https://www1.racgp.org.au/ajgp/2021/april/end-stage-kidney-disease-the-last-12-months-1

  Although the patient is not undergoing dialysis, the nephrologist should continue to care for their conservatively managed patients. […] Actively treating the complications of ESKD can improve quality of life and improve the symptom burden. […] Advance care planning is a process of communication, understanding, and discussion between a patient, their caregivers and healthcare providers, with the goal of clarifying values and preferences for future care, including care at the end of life. […] The care of patients with ESKD, up to and including the final year of their lives, requires a careful and respectful coordination of the relevant specialist services and general practice.

• #49 End-Stage Renal Disease (ESRD): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

  Discuss vascular access options. […] Instruct on peritoneal dialysis. […] Prepare for a kidney transplant. […] Discuss palliative and end-of-life care. […] Once the nurse identifies nursing diagnoses for end-stage renal disease, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. […] Deficient knowledge related to end-stage renal disease can be caused by misinformation, leading to further complications and poor outcomes. […] Excess fluid volume related to end-stage renal disease can be caused by kidneys losing their ability to remove excess fluid leading to fluid overload (hypervolemia). […] Imbalanced nutrition related to end-stage renal disease can be caused by disease process, chronic inflammation, uremic toxins, metabolic acidosis, and food aversion.

• #50 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  Patients, families, and some medical professionals may erroneously think that choosing not to start dialysis is equivalent to stopping dialysis. Although patients who discontinue dialysis die within one to two weeks, patients who decline dialysis initiation can live for months to years. Studies have showed that patients who refuse dialysis have a median life expectancy of 6.3 to 23.4 months. […] Family physicians can counsel older patients and those with multiple comorbidities that nondialytic management is a viable option in end-stage renal disease. […] Advance directives (i.e., a living will and durable power of attorney for health care) can guide physicians in end-of-life decision making. In addition, patients who complete written advance directives are more likely to informally discuss their wishes for specific medical interventions with their families. As many as one-half of patients who receive dialysis do not have advance directives. […] Family physicians can facilitate preemptive conversations about these issues with patients and their decision makers.

• #51 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Shared decision-making should be used, with adequate time for patients to consider the various dialysis modalities and the option of conservative management. […] Most patients with ESRD will be treated with hemodialysis, and arteriovenous access (fistula or graft) is usually preferred. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] People with ESRD are at high risk of developing protein-energy wasting and other malnutrition disorders and should receive nutritional counseling from a registered dietitian. […] Most patients receiving dialysis have hypertension.

• #52 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Kidney transplantation is the treatment of choice for appropriate candidates, and it requires considerable preparation and planning. […] Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] It is essential to treat ESRD complications that may arise. […] Psychiatric disorders are common in the context of kidney disease and can interfere with treatment. […] Exercise should be encouraged in ESRD patients. […] Compared with the general population, patients with ESRD have significantly worse outcomes after cardiac arrest.

• #53 Chronic Kidney Disease Nursing Care Plans

  https://www.healthline.com/health/kidney-disease/kidney-failure-care-plan

  Nurses keep track of output, which is how much and how often you urinate in relation to the amount of liquid you consume throughout the day. […] If you are not urinating enough, healthcare professionals may use interventions such as diuretic medication or insertion of a catheter. […] If they find symptoms of excess fluid retention, they will begin interventions such as: restricting fluids, giving you diuretic medications, treating any areas of swelling to prevent skin breakdown, preparing you for dialysis treatments if you have stage 5 CKD. […] Nurses will monitor your lab results and other vital signs daily to maintain this balance. […] If they suspect an imbalance, they may begin interventions such as providing lactose solution, giving diuretic medications, and suggesting dietary changes.

• #54 Chronic Kidney Disease Nursing Care Plans

  https://www.healthline.com/health/kidney-disease/kidney-failure-care-plan

  Nurses monitoring your CKD will take your blood pressure regularly. […] Interventions might include diuretic medications and education on dietary and lifestyle changes. […] Its important to work closely with your medical team to manage symptoms of CKD. […] Nursing care plans and interventions can help slow the progression of kidney disease and prolong kidney function. […] You cant reverse CKD, but interventions such as a nursing care plan can help slow the progression and prevent secondary conditions such as heart disease. […] Nursing care plans help healthcare professionals monitor and manage CKD progression by providing guidelines for identifying and resolving issues with fluid retention, urinary output, electrolyte balance, and other kidney-related functions. […] If kidney-related functions arent falling within the identified range for a specific stage of kidney disease, CKD care plans will recommend interventions to help address the issue. […] Common interventions include diuretic medications, dietary changes, and patient education.

• #55 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Shared decision-making should be used, with adequate time for patients to consider the various dialysis modalities and the option of conservative management. […] Most patients with ESRD will be treated with hemodialysis, and arteriovenous access (fistula or graft) is usually preferred. […] Patients with ESRD can elect a palliative approach to managing their disease that does not involve dialysis. […] Given the limited life expectancy for most patients with ESRD who do not undergo kidney transplantation, routine cancer screening is discouraged in these patients. […] People with ESRD are at high risk of developing protein-energy wasting and other malnutrition disorders and should receive nutritional counseling from a registered dietitian. […] Most patients receiving dialysis have hypertension.

• #56 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  Blood pressure control is closely associated with volume status, modifying dialysis sessions to maintain normovolemia can improve blood pressure control. […] Clinicians caring for patients with ESRD should be aware of its many complications. […] Chronic kidney disease is considered a coronary heart disease risk equivalent, and patients with ESRD are at high risk of cardiovascular complications and death. […] Pericarditis is not uncommon in patients with ESRD and can manifest differently in this population.

• #57 End-stage renal disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538

  During a kidney biopsy, your doctor uses a needle to remove a small sample of kidney tissue for lab testing. […] To diagnose end-stage renal disease, your health care provider may ask you about your family’s and your medical history. […] When your kidneys no longer work at a level that’s necessary to keep you alive, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 15% of typical kidney function. […] Our caring team of Mayo Clinic experts can help you with your end-stage renal disease-related health concerns. […] End-stage renal disease treatments include: Kidney transplant, Dialysis, Supportive care. […] A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis. […] Dialysis does some of the work of your kidneys when your kidneys can’t do it themselves.

• #58 End-stage renal disease | Altru Health System

  https://www.altru.org/health-library/conditions/end-stage-renal-disease

  End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease the gradual loss of kidney function reaches an advanced state. […] In end-stage renal disease, your kidneys no longer work as they should to meet your body’s needs. […] With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also choose to opt for conservative care to manage your symptoms aiming for the best quality of life during your remaining time. […] End-stage renal disease treatments include: Kidney transplant, Dialysis, Supportive care. […] A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis. […] Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. […] If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. […] After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis.

• #59 End-Stage Renal Disease | Nutrition Guide for Clinicians

  https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342059/all/End_Stage_Renal_Disease

  Kidney transplantation is the treatment of choice for appropriate candidates, and it requires considerable preparation and planning. […] Hemodialysis typically involves the surgical creation of an arteriovenous fistula (a connection between an artery and vein), usually in the forearm. […] Peritoneal dialysis involves inserting the dialysate into the patients abdomen and allowing dialysis to occur continuously or intermittently without requiring the patient to travel regularly to a dialysis center. […] It is essential to treat ESRD complications that may arise. […] Psychiatric disorders are common in the context of kidney disease and can interfere with treatment. […] Exercise should be encouraged in ESRD patients. […] Compared with the general population, patients with ESRD have significantly worse outcomes after cardiac arrest.

• #60 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  Every 24 hours, over 300 people begin dialysis for end-stage renal disease (ESRD) in the US. […] Adults with ESRD on maintenance hemodialysis (HD) live a life structured around treatments to manage their disease, which in turn can result in feelings of lost freedom. […] An estimated 20% to 30% of adults with ESRD experience depressive symptoms. […] When admitted to the hospital for related or unrelated health concerns, patients may experience a further sense of mental and emotional distress due to losing control of their environment and daily activities. […] Apart from performing physical and vital sign assessments of treatment tolerance and effectiveness, how are nurses monitoring a patients mental and emotional well-being? […] Sadda et al. found that positive patient experiences during HD resulted in improved health outcomes.

• #61 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  Screening by nurses during HD can show meaningful findings regarding anxiety, depression, and resiliency in patients. […] Unfortunately, HD nurses have reported difficulty in holistically and safely caring for patients due to staffing dilemmas. […] This project highlighted the need for HD nurses to assess the psychological and emotional well-being of patients requiring HD. […] A survey tool may aid in improving the nurse-patient relationship and creating patient-centered, holistic care. […] Collaboration with hospital leadership should be considered since multiple HD nurses stated that the lack of time spent with patients was mainly due to inadequate staffing and increased patient census. […] Future projects and research should focus on exploring additional screening methods of patient knowledge regarding disease management.

• #62 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  Through this relationship, the role of clinicians can expand and evolve to include the assessment of patients mental health and optimize their sense of well-being and QOL. […] Clinicians must take the additional time to gain an understanding of adults with ESRD undergoing exhaustive, time-consuming, and mentally draining treatment regimens. […] This quality improvement (QI) project examined the experiences of hospitalized adults with ESRD undergoing maintenance HD to determine whether routine screening of psychological and emotional well-being can aid in optimizing patients perceived sense of wellbeing and improve the role of HD nurses in promoting patients self-reflection during HD and providing patient-centered, holistic care compared with current standards of care. […] Nurses could help patients define their sense of well-being as well as offer a sense of capacity that they are present in the now.

• #63 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  When faced with adversity, self-transcendence could be a powerful coping strategy. […] This population may have a poor sense of well-being because of their disease and a fear of the unknown. […] Research has shown that nurses could facilitate well-being in individuals facing health-related challenges using their nursing practice knowledge along with their basic knowledge of individuals inner nursing processes. […] Nephrology nurses have reported a lack of communication skills and training in addressing vulnerable topics such as the psychosocial and spiritual needs of their patients. […] Enhanced training and education, along with interdisciplinary collaboration, can aid in improved communication with patients requiring HD. […] While it is important for nephrologists and NPs to routinely screen their patients mental health, it is also useful for RNs to perform it as well.

• #64 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  Screening by nurses during HD can show meaningful findings regarding anxiety, depression, and resiliency in patients. […] Unfortunately, HD nurses have reported difficulty in holistically and safely caring for patients due to staffing dilemmas. […] This project highlighted the need for HD nurses to assess the psychological and emotional well-being of patients requiring HD. […] A survey tool may aid in improving the nurse-patient relationship and creating patient-centered, holistic care. […] Collaboration with hospital leadership should be considered since multiple HD nurses stated that the lack of time spent with patients was mainly due to inadequate staffing and increased patient census. […] Future projects and research should focus on exploring additional screening methods of patient knowledge regarding disease management.

• #65 Nursing August 2023: End-stage renal disease and hemodialysis: Improving nursing care and patient experience

  https://www.qgdigitalpublishing.com/article/End-stage+renal+disease+and+hemodialysis%3A+Improving+nursing+care+and+patient+experience/4608410/796427/article.html

  Screening by nurses during HD can show meaningful findings regarding anxiety, depression, and resiliency in patients. […] Unfortunately, HD nurses have reported difficulty in holistically and safely caring for patients due to staffing dilemmas. […] This project highlighted the need for HD nurses to assess the psychological and emotional well-being of patients requiring HD. […] A survey tool may aid in improving the nurse-patient relationship and creating patient-centered, holistic care. […] Collaboration with hospital leadership should be considered since multiple HD nurses stated that the lack of time spent with patients was mainly due to inadequate staffing and increased patient census. […] Future projects and research should focus on exploring additional screening methods of patient knowledge regarding disease management.

• #66 End-Stage Renal Disease: Medical Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1100/p493.html

  End-stage renal disease (ESRD) is diagnosed when kidney function is no longer adequate for long-term survival without kidney transplantation or dialysis. […] The decision to initiate dialysis is best made through shared decision-making. […] A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, with severe comorbid conditions, or who wish to avoid medical interventions. […] For patients with ESRD, vaccination against seasonal influenza, tetanus, hepatitis B, human papillomavirus (through 26 years of age), and Streptococcus pneumoniae is advised. […] Insulin is the preferred treatment for patients with ESRD and diabetes mellitus requiring medication. […] Patients should be monitored for signs of protein-energy wasting and malnutrition.

• #67 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Fast Fact Number: 408 […] Background ESRD describes advanced kidney failure (typically a glomerular filtration rate < 15 ml/min/m2) and is the point at which many patients start dialysis if they cannot receive a kidney transplant. Conservative management (CM) refers to the management of the symptoms and signs of ESRD in patients who do not receive dialysis or transplantation, whether due to personal preference or comorbidities (e.g., dementia, advanced frailty). Significant symptom burden is common in patients with ESRD nearing the end-of life, including those receiving CM (1). [...] Lack of energy Depression (see Fast Fact #404), volume imbalance, sleep disorders, poor nutrition, and anemia are common underlying causes of fatigue in patients with ESRD. Blood transfusions have been shown to improve fatigue and self-reported well-being for palliative care patients who are anemic (2). Erythropoietin-stimulating agents are transfusion-sparing interventions that can similarly mitigate fatigue and enhance quality of life for select ESRD patients on CM (3). Psychostimulants do not have supporting evidence in the CKD population and may cause anorexigenic and cardiovascular effects (4).

• #68 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  Symptom management and advance care planning are crucial for these patients. Family physicians may be called on to address advance directives or to support patients and families in decisions about dialysis initiation or withdrawal. In addition, family physicians must be prepared to manage symptoms associated with end-stage renal disease and adjust medication dosages appropriately. […] The decision to initiate dialysis is usually made by a nephrologist, but family physicians are ideally positioned to collaborate with nephrologists and counsel patients and families when decision making is difficult. This may be especially important when the patient is older or when there are additional life-limiting diseases. […] In response to the aging population and trends of dialyzing older and sicker patients, there has been growing interest in nondialytic alternatives for managing end-stage renal disease. The Renal Physicians Association and the American Society of Nephrology issued a practice guideline affirming the rights of patients to decline dialysis. Nondialytic management includes careful attention to fluid balance, treatment of anemia, and correction of acidosis and hyperkalemia. Blood pressure and metabolism of calcium and phosphorus must also be monitored. There is emerging evidence that dietary modifications may be helpful in prolonging life and decreasing symptoms.

• #69 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Fast Fact Number: 408 […] Background ESRD describes advanced kidney failure (typically a glomerular filtration rate < 15 ml/min/m2) and is the point at which many patients start dialysis if they cannot receive a kidney transplant. Conservative management (CM) refers to the management of the symptoms and signs of ESRD in patients who do not receive dialysis or transplantation, whether due to personal preference or comorbidities (e.g., dementia, advanced frailty). Significant symptom burden is common in patients with ESRD nearing the end-of life, including those receiving CM (1). [...] Lack of energy Depression (see Fast Fact #404), volume imbalance, sleep disorders, poor nutrition, and anemia are common underlying causes of fatigue in patients with ESRD. Blood transfusions have been shown to improve fatigue and self-reported well-being for palliative care patients who are anemic (2). Erythropoietin-stimulating agents are transfusion-sparing interventions that can similarly mitigate fatigue and enhance quality of life for select ESRD patients on CM (3). Psychostimulants do not have supporting evidence in the CKD population and may cause anorexigenic and cardiovascular effects (4).

• #70 What is End-Stage Kidney Disease? Kidney Disease Information

  https://www.samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/end-stage-kidney-disease-expect/

  End-stage kidney disease is when the kidneys lose the ability to function and filter excess fluids from the blood, creating a build-up within the body. […] When your kidneys fail, it means they have stopped working well enough to survive without dialysis or a kidney transplant. […] In cases when people are unable to receive dialysis or a transplant, or these treatments may not work, patients can choose hospice care. Hospice helps keep patients comfortable by controlling pain and other symptoms. […] Symptom relief is essential to end-stage kidney-disease patients, as their quality of life is often reduced by multiple symptoms including fatigue, cramping, and more. […] People with end-stage kidney disease can benefit from palliative or hospice care, which focus on relieving symptoms and maximizing quality of life.

• #71 What is End-Stage Kidney Disease? Kidney Disease Information

  https://www.samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/end-stage-kidney-disease-expect/

  End-stage kidney disease is when the kidneys lose the ability to function and filter excess fluids from the blood, creating a build-up within the body. […] When your kidneys fail, it means they have stopped working well enough to survive without dialysis or a kidney transplant. […] In cases when people are unable to receive dialysis or a transplant, or these treatments may not work, patients can choose hospice care. Hospice helps keep patients comfortable by controlling pain and other symptoms. […] Symptom relief is essential to end-stage kidney-disease patients, as their quality of life is often reduced by multiple symptoms including fatigue, cramping, and more. […] People with end-stage kidney disease can benefit from palliative or hospice care, which focus on relieving symptoms and maximizing quality of life.

• #72 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient’s renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

• #73 End-Stage Renal Disease: Symptom Management and Advance Care Planning | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p705.html

  Patients, families, and some medical professionals may erroneously think that choosing not to start dialysis is equivalent to stopping dialysis. Although patients who discontinue dialysis die within one to two weeks, patients who decline dialysis initiation can live for months to years. Studies have showed that patients who refuse dialysis have a median life expectancy of 6.3 to 23.4 months. […] Family physicians can counsel older patients and those with multiple comorbidities that nondialytic management is a viable option in end-stage renal disease. […] Advance directives (i.e., a living will and durable power of attorney for health care) can guide physicians in end-of-life decision making. In addition, patients who complete written advance directives are more likely to informally discuss their wishes for specific medical interventions with their families. As many as one-half of patients who receive dialysis do not have advance directives. […] Family physicians can facilitate preemptive conversations about these issues with patients and their decision makers.

• #74 What is End-Stage Kidney Disease? Kidney Disease Information

  https://www.samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/end-stage-kidney-disease-expect/

  Palliative care can be given at any time during the course of kidney disease (or other serious illness). Hospice care is available to people whose life expectancy is six months or less. […] Palliative/hospice providers can help address pain. Up to half of patients on dialysis have problems with pain. Palliative/hospice providers can prescribe opioids that are safe for people with end-stage kidney disease. […] Palliative/hospice providers can determine the cause of the fatigue, such as anemia or depression, and provide appropriate treatment. […] Palliative/hospice providers can ensure optimal fluid balance, and encourage physical activity in those who are capable. […] Palliative/hospice providers can help patients and families make decisions about care. These decisions are especially important for older patients and those with multiple serious illnesses. […] Furthermore, hospice offers emotional and spiritual support to patients and families as they make these difficult decisions.

• #75 Hospice Eligibility Guidelines: Renal & Kidney Disease | VITAS Healthcare

  https://www.vitas.com/for-healthcare-professionals/hospice-eligibility-guidelines/renal-disease

  Hospice helps to reduce hospitalization, minimize pain and symptoms, and improve quality of life. […] The hospice plan of care for end-stage renal disease (ESRD) addresses the patient’s physical and psychosocial well-being and seeks to manage a wide variety of kidney failure symptoms, including: Pain, Fatigue, Loss of appetite, Nausea and vomiting, Itching, Difficulty breathing, Difficulty sleeping, Anxiety, Depression. […] Withdrawing from dialysis, or choosing to forgo it altogether, is often an emotionally difficult process. Hospice offers emotional and spiritual support for patients and their loved ones. […] Patients with ESRD are increasingly characterized by older age and multiple comorbid illnesses, and have a mortality rate eight times higher than the general Medicare population. Dialysis patients are appropriate for palliative care because of their high mortality rate and high symptom burden.

• #76 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Hospice Prognosis is protracted for patients with ESRD on CM, with survival ranging from around 6 to 23 months (19). This is in sharp contrast to patients stopping dialysis, whose median life expectancy is around 7 days (20). As a result, hospice eligibility varies. In addition to an estimated GFR of <15 ml/min, hospice evaluation for CM patients is warranted for: 1) uncontrolled metabolic derangements such as hyperkalemia and acidemia, 2) uremic symptoms causing frailty or encephalopathy, 3) critical volume overload causing respiratory issues or nephrogenic ascites, and 4) calciphylaxis (21). Early referral to hospice has the potential to reduce healthcare dollar spending and to improve quality of life while effectively managing symptoms as patients approach their end of life (22).

• #77 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Hospice Prognosis is protracted for patients with ESRD on CM, with survival ranging from around 6 to 23 months (19). This is in sharp contrast to patients stopping dialysis, whose median life expectancy is around 7 days (20). As a result, hospice eligibility varies. In addition to an estimated GFR of <15 ml/min, hospice evaluation for CM patients is warranted for: 1) uncontrolled metabolic derangements such as hyperkalemia and acidemia, 2) uremic symptoms causing frailty or encephalopathy, 3) critical volume overload causing respiratory issues or nephrogenic ascites, and 4) calciphylaxis (21). Early referral to hospice has the potential to reduce healthcare dollar spending and to improve quality of life while effectively managing symptoms as patients approach their end of life (22).

• #78 FF #408 Conservative Management of Patients With End Stage Renal Disease | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/conservative-management-of-patients-with-end-stage-renal-disease/

  Hospice Prognosis is protracted for patients with ESRD on CM, with survival ranging from around 6 to 23 months (19). This is in sharp contrast to patients stopping dialysis, whose median life expectancy is around 7 days (20). As a result, hospice eligibility varies. In addition to an estimated GFR of <15 ml/min, hospice evaluation for CM patients is warranted for: 1) uncontrolled metabolic derangements such as hyperkalemia and acidemia, 2) uremic symptoms causing frailty or encephalopathy, 3) critical volume overload causing respiratory issues or nephrogenic ascites, and 4) calciphylaxis (21). Early referral to hospice has the potential to reduce healthcare dollar spending and to improve quality of life while effectively managing symptoms as patients approach their end of life (22).

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