FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2064621036> ?p ?o ?g. }

• W2064621036 endingPage "516" @default.
• W2064621036 startingPage "514" @default.
• W2064621036 abstract "The intensity of medical care for those aged 75 years or older has escalated beyond population growth in the past decade.1Kurella M. Covinsky K.E. Collins A.J. Chertow G.M. Octogenarians and nonagenarians starting dialysis in the United States.Ann Intern Med. 2007; 146: 177-183Crossref PubMed Scopus (441) Google Scholar, 2Sharma G. Freeman J. Zhang D. Goodwin J.S. Trends in end-of-life ICU use among older adults with advanced lung cancer.Chest. 2008; 133: 72-78Crossref PubMed Scopus (90) Google Scholar This has happened despite a concurrent growth of palliative care with an emphasis on goals of care and quality of life (QoL). The technological imperative3Fuchs V.R. The growing demand for medical care.N Engl J Med. 1968; 279: 190-195Crossref PubMed Scopus (78) Google Scholar and access to advanced health care technology drives aggressive care irrespective of age, with a concurrent loss of focus on the health and QoL of the elderly patient.4Kaufman S.R. Shim J.K. Russ A.J. Revisiting the biomedicalization of aging: clinical trends and ethical challenges.Gerontologist. 2004; 44: 731-738Crossref PubMed Scopus (139) Google Scholar This phenomenon may partly account for the results of a recent national survey, which showed that a majority of primary care providers believe their patients are overtreated.5Sirovich B.E. Woloshin S. Schwartz L.M. Too little? Too much? Primary care physicians' views on US health care: a brief report.Arch Intern Med. 2011; 171: 1582-1585Crossref PubMed Scopus (106) Google Scholar Hemodialysis (HD) therapy in frail elderly patients is an example of this trend. In this article, we outline recent developments and outcomes of HD treatment for patients aged 75 years or older and provide arguments for an alternative approach in which patients' health care–related goals and QoL take center stage. The demand for HD has increased rapidly in recent decades, with the elderly (65 years and older) being the largest driver of utilization.6US Renal Data SystemUSRDS 2011 Annual Data Report, Vol 2: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2011Google Scholar Between 1996 and 2003, there was a 57% increase in the age-adjusted rate of HD for octogenarians and nonagenarians in the United States.1Kurella M. Covinsky K.E. Collins A.J. Chertow G.M. Octogenarians and nonagenarians starting dialysis in the United States.Ann Intern Med. 2007; 146: 177-183Crossref PubMed Scopus (441) Google Scholar Hemodialysis was also started in patients with a higher glomerular filtration rate (mean, 10.5 mL/min) and less chronic renal disease morbidity1Kurella M. Covinsky K.E. Collins A.J. Chertow G.M. Octogenarians and nonagenarians starting dialysis in the United States.Ann Intern Med. 2007; 146: 177-183Crossref PubMed Scopus (441) Google Scholar because earlier treatment was believed to improve outcomes. In addition, many recent studies have shown improved clinical end points with more frequent HD and home HD.7Johansen K.L. Zhang R. Huang Y. et al.Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study.Kidney Int. 2009; 76: 984-990Crossref PubMed Scopus (160) Google Scholar As a result, HD utilization could increase even more in all age groups. This begs the question of whether frequent HD will improve QoL and survival among the very elderly. Without this knowledge, the option of frequent HD may further increase the treatment burden for these individuals without achieving their goals for QoL. As HD has become established as standard care for patients with end-stage renal disease (ESRD), physicians and patients alike may believe that they have little choice but to start HD or other forms of renal replacement therapy. Urgent decisions about starting HD are often made in the acute care setting in which an illness has resulted in acute renal failure or significant worsening of chronic renal failure.8Marrón B. Martínez Ocaña J.C. Salgueira M. et al.Spanish Group for CKDAnalysis of patient flow into dialysis: role of education in choice of dialysis modality.Perit Dial Int. 2005; 25: S56-S59PubMed Google Scholar Patients report being rushed to make decisions at a time when they are too sick to process the information given.9Morton R.L. Tong A. Howard K. Snelling P. Webster A.C. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies.BMJ. 2010; 340: c112Crossref PubMed Scopus (365) Google Scholar Studies have shown that patients with ESRD have limited knowledge of their prognosis and that few have been presented with alternative treatment options.10Stringer S. Baharani J. Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom.Int Urol Nephrol. 2011; 44: 295-300Crossref PubMed Scopus (27) Google Scholar, 11Davison S.N. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 195-204Crossref PubMed Scopus (457) Google Scholar In a recent Canadian study, two-thirds of patients with chronic kidney disease (CKD) indicated that they chose HD over supportive care because it was their physician's (52%) or family's (14%) wish, and 61% of these dialysis patients regretted having started HD.11Davison S.N. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 195-204Crossref PubMed Scopus (457) Google Scholar These findings are similar to those of a small qualitative study that showed that at 6 months after the start of HD, only 45% of patients found HD acceptable and that the symptom burden was higher at 6 months than at initiation of dialysis treatment.10Stringer S. Baharani J. Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom.Int Urol Nephrol. 2011; 44: 295-300Crossref PubMed Scopus (27) Google Scholar The prevalence of death attributable to withdrawal of dialysis has increased to 25% to 34% in patients 75 years and older.12US Renal Data SystemUSRDS 2008 Annual Data Report, Vol 2: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2008Google Scholar Additionally, 37% of patients lack decision-making capacity when the decision to discontinue HD is made,13Sekkarie M.A. Moss A.H. Withholding and withdrawing dialysis: the role of physician specialty and education and patient functional status.Am J Kidney Dis. 1998; 31: 464-472Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar which can add to the burden of surrogates. The high level of both regret for having started HD and subsequent withdrawal from HD suggests an approach for this age group that may be incongruent with the patients' wishes, and that treatment burdens may outweigh its benefits. Elderly patients with ESRD receiving HD have similar symptom burden and life expectancy as patients with cancer.6US Renal Data SystemUSRDS 2011 Annual Data Report, Vol 2: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2011Google Scholar, 14Murtagh F.E. Addington-Hall J. Higginson I.J. The prevalence of symptoms in end-stage renal disease: a systematic review.Adv Chronic Kidney Dis. 2007; 14: 82-99Abstract Full Text Full Text PDF PubMed Scopus (632) Google Scholar Nevertheless, HD has been shown to prolong life in persons older than 75 years, although this survival advantage is lost in patients with high comorbidity scores, especially those with heart disease.15Murtagh F.E. Marsh J.E. Donohoe P. Ekbal N.J. Sheerin N.S. Harris F.E. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.Nephrol Dial Transplant. 2007; 22: 1955-1962Crossref PubMed Scopus (512) Google Scholar With suboptimal patient selection, much of the survival time may be spent in the hospital or dialysis unit.16Carson R.C. Juszczak M. Davenport A. Burns A. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease?.Clin J Am Soc Nephrol. 2009; 4: 1611-1619Crossref PubMed Scopus (339) Google Scholar Once dialysis has been initiated, the 90-day mortality has been reported to be as high as 30% in those older than 84,17Michael C. Khayat R. Viron B. et al.Early mortality during renal replacement therapy (RRT) in ESRD patients 65 years and over [abstract].J Am Soc Nephrol. 1993; 4: 369Google Scholar and 1-year mortality ranges from 46% to 58%.1Kurella M. Covinsky K.E. Collins A.J. Chertow G.M. Octogenarians and nonagenarians starting dialysis in the United States.Ann Intern Med. 2007; 146: 177-183Crossref PubMed Scopus (441) Google Scholar, 18Lamping D.L. Constantinovici N. Roderick P. et al.Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study.Lancet. 2000; 356: 1543-1550Abstract Full Text Full Text PDF PubMed Scopus (327) Google Scholar, 19Kurella Tamura M. Covinsky K.E. Chertow G.M. Yaffe K. Landefeld C.S. McCulloch C.E. Functional status of elderly adults before and after initiation of dialysis.N Engl J Med. 2009; 361: 1539-1547Crossref PubMed Scopus (752) Google Scholar Studies underscore that comorbidities and functional status are stronger predictors of outcome than chronological age.18Lamping D.L. Constantinovici N. Roderick P. et al.Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study.Lancet. 2000; 356: 1543-1550Abstract Full Text Full Text PDF PubMed Scopus (327) Google Scholar In addition to patients with heart disease, patients with dementia prior to the initiation of HD do particularly poorly, with an average time to death of 1.09 years and a 2-year survival of 24%, compared to 66% in patients receiving dialysis who do not have dementia.20Rakowski D.A. Caillard S. Agodoa L.Y. Abbott K.C. Dementia as a predictor of mortality in dialysis patients.Clin J Am Soc Nephrol. 2006; 1: 1000-1005Crossref PubMed Scopus (95) Google Scholar There is a substantial functional decline associated with the initiation of HD in the elderly nursing home population, with only 13% maintaining predialysis functional status at 12 months.19Kurella Tamura M. Covinsky K.E. Chertow G.M. Yaffe K. Landefeld C.S. McCulloch C.E. Functional status of elderly adults before and after initiation of dialysis.N Engl J Med. 2009; 361: 1539-1547Crossref PubMed Scopus (752) Google Scholar These patients do functionally worse on HD than patients who never started HD, inasmuch as the non-HD patients usually maintain a stable functional status until 1 to 2 months before death.21Murtagh F.E. Addington-Hall J.M. Higginson I.J. End-stage renal disease: a new trajectory of functional decline in the last year of life.J Am Geriatr Soc. 2011; 59: 304-308Crossref PubMed Scopus (90) Google Scholar Despite a growing trend toward earlier nephrology referral and initiation of HD for elderly patients with CKD, there has not been a significant improvement in 1-year dialysis survival rates.22Winkelmayer W.C. Liu J. Chertow G.M. Tamura M.K. Predialysis nephrology care of older patients approaching end-stage renal disease.Arch Intern Med. 2011; 171: 1371-1378Crossref PubMed Scopus (59) Google Scholar Life expectancy for 70- to 74-year-old patients with ESRD undergoing HD is 3.3 years (compared to 13.8 years in the general US population for this age cohort), but only 1.9 years for those older than 85 years.12US Renal Data SystemUSRDS 2008 Annual Data Report, Vol 2: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2008Google Scholar In an elderly English cohort with a mean glomerular filtration rate of 12 mL/min, a multidisciplinary team approach using best supportive care without HD achieved 1-year overall survival of 65%, which rivals that of HD treatment. The median overall survival was 1.95 years, and of the patients who died, 71% died at home.23Wong C.F. McCarthy M. Howse M.L. Williams P.S. Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis.Ren Fail. 2007; 29: 653-659Crossref PubMed Scopus (85) Google Scholar Patients report being comfortable discussing end-of-life issues with both family and nephrology staff. Fifty percent of patients with ESRD reported that they would prefer to have these discussions with their nephrologist and 39% with their family doctor.11Davison S.N. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 195-204Crossref PubMed Scopus (457) Google Scholar Moreover, patients expect their physicians to initiate these conversations.24Fine A. Fontaine B. Kraushar M.M. Rich B.R. Nephrologists should voluntarily divulge survival data to potential dialysis patients: a questionnaire study.Perit Dial Int. 2005; 25: 269-273PubMed Google Scholar An overwhelming majority (97%) also prefer detailed information about survival during their first visit to a nephrologist, before giving informed consent for HD.24Fine A. Fontaine B. Kraushar M.M. Rich B.R. Nephrologists should voluntarily divulge survival data to potential dialysis patients: a questionnaire study.Perit Dial Int. 2005; 25: 269-273PubMed Google Scholar Shared decision-making tools have been developed to predict early or short-term mortality in patients undergoing HD.25Couchoud C. Dialysis: can we predict death in patients on dialysis?.Nat Rev Nephrol. 2010; 6: 388-389Crossref Scopus (8) Google Scholar These tools classify patients' mortality risk and establish hospice eligibility for those in the highest risk percentiles. Risk stratification can serve as a good basis for discussion with patients and families when reviewing treatment options. End-stage renal disease has a distinctive disease trajectory when managed conservatively, with a stable functional status maintained through most of the terminal year until a precipitous drop-off is observed in the last 1 to 2 months of life.21Murtagh F.E. Addington-Hall J.M. Higginson I.J. End-stage renal disease: a new trajectory of functional decline in the last year of life.J Am Geriatr Soc. 2011; 59: 304-308Crossref PubMed Scopus (90) Google Scholar This disease trajectory most closely resembles that of cancer and thus would be a good fit for a hospice and/or palliative care philosophy. Palliative care should be offered to all patients who suffer with the burdens of their disease or its treatment. Palliative care does not preclude renal replacement therapy; indeed, it can and should be done concurrently with HD. While the integration of the principles of palliative care into the HD population has grown in the past decade, barriers remain. Nearly half (48.8%) of graduating nephrology fellows do not feel competent providing end-of-life care.26Berns J.S. A survey-based evaluation of self-perceived competency after nephrology fellowship training.Clin J Am Soc Nephrol. 2010; 5: 490-496Crossref PubMed Scopus (113) Google Scholar Hospice utilization for the dying HD patient remains low, even for those patients who choose to withdraw from HD.27Murray A.M. Arko C. Chen S.C. Gilbertson D.T. Moss A.H. Use of hospice in the United States dialysis population.Clin J Am Soc Nephrol. 2006; 1: 1248-1255Crossref PubMed Scopus (124) Google Scholar Specific programs designed to overcome some of these barriers, such as the Renal Palliative Care Initiative at Baystate Medical Center, have shown promise.28Poppel D.M. Cohen L.M. Germain M.J. The Renal Palliative Care Initiative.J Palliat Med. 2003; 6: 321-326Crossref PubMed Scopus (51) Google Scholar Their approach consists of systematic symptom assessment, evidence-based treatment guidelines, morbidity and mortality conferences, bereavement services, systematic advanced care planning, and facilitating hospice referral. This approach provides HD patients and their families with continuous palliative care throughout the disease and bereavement process. We believe that the principles guiding these programs deserve more widespread consideration and implementation. When faced with options for ESRD treatment, elderly patients and their loved ones need help in understanding the severity of their prognosis. Hemodialysis may prolong life in some, but it often fails to restore health. The patient's health care and QoL goals should be the main focus when considering whether or not to start HD in the frail elderly patient. Physicians must be careful not to encourage unrealistic expectations of the benefits of dialysis and be frank about the associated risks and modest impact on survival. Patients with ESRD also need to have a realistic expectation of how renal replacement therapy will impact their daily life. Alternative treatment regimens such as peritoneal dialysis, home HD, best supportive care, and hospice should be presented as viable options compared with standard or more frequent in-center HD. Ideally, these discussions start early in the course of CKD and continue longitudinally, so that the patient's goals of care have time to mature before he is faced with making a choice." @default.
• W2064621036 created "2016-06-24" @default.
• W2064621036 creator A5010011029 @default.
• W2064621036 creator A5049282067 @default.
• W2064621036 creator A5059812558 @default.
• W2064621036 creator A5080880751 @default.
• W2064621036 creator A5086605496 @default.
• W2064621036 date "2012-06-01" @default.
• W2064621036 modified "2023-09-23" @default.
• W2064621036 title "Are There Alternatives to Hemodialysis for the Elderly Patient With End-Stage Renal Failure?" @default.
• W2064621036 cites W1560022178 @default.
• W2064621036 cites W1968128755 @default.
• W2064621036 cites W1974856898 @default.
• W2064621036 cites W1977414865 @default.
• W2064621036 cites W1980593983 @default.
• W2064621036 cites W1998709339 @default.
• W2064621036 cites W2012479260 @default.
• W2064621036 cites W2015692295 @default.
• W2064621036 cites W2021504551 @default.
• W2064621036 cites W2031092381 @default.
• W2064621036 cites W2057001161 @default.
• W2064621036 cites W2064523978 @default.
• W2064621036 cites W2079981676 @default.
• W2064621036 cites W2120777698 @default.
• W2064621036 cites W2122886742 @default.
• W2064621036 cites W2124651748 @default.
• W2064621036 cites W2124864480 @default.
• W2064621036 cites W2131888124 @default.
• W2064621036 cites W2134783323 @default.
• W2064621036 cites W2149481791 @default.
• W2064621036 cites W2150059819 @default.
• W2064621036 cites W2157260213 @default.
• W2064621036 cites W2157664222 @default.
• W2064621036 cites W2169328204 @default.
• W2064621036 cites W2188945950 @default.
• W2064621036 doi "https://doi.org/10.1016/j.mayocp.2012.02.016" @default.
• W2064621036 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/3498386" @default.
• W2064621036 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/22677071" @default.
• W2064621036 hasPublicationYear "2012" @default.
• W2064621036 type Work @default.
• W2064621036 sameAs 2064621036 @default.
• W2064621036 citedByCount "15" @default.
• W2064621036 countsByYear W20646210362012 @default.
• W2064621036 countsByYear W20646210362013 @default.
• W2064621036 countsByYear W20646210362015 @default.
• W2064621036 countsByYear W20646210362016 @default.
• W2064621036 countsByYear W20646210362017 @default.
• W2064621036 countsByYear W20646210362018 @default.
• W2064621036 countsByYear W20646210362019 @default.
• W2064621036 countsByYear W20646210362022 @default.
• W2064621036 countsByYear W20646210362023 @default.
• W2064621036 crossrefType "journal-article" @default.
• W2064621036 hasAuthorship W2064621036A5010011029 @default.
• W2064621036 hasAuthorship W2064621036A5049282067 @default.
• W2064621036 hasAuthorship W2064621036A5059812558 @default.
• W2064621036 hasAuthorship W2064621036A5080880751 @default.
• W2064621036 hasAuthorship W2064621036A5086605496 @default.
• W2064621036 hasBestOaLocation W20646210361 @default.
• W2064621036 hasConcept C126322002 @default.
• W2064621036 hasConcept C177713679 @default.
• W2064621036 hasConcept C2778063415 @default.
• W2064621036 hasConcept C3019040382 @default.
• W2064621036 hasConcept C3019848702 @default.
• W2064621036 hasConcept C71924100 @default.
• W2064621036 hasConceptScore W2064621036C126322002 @default.
• W2064621036 hasConceptScore W2064621036C177713679 @default.
• W2064621036 hasConceptScore W2064621036C2778063415 @default.
• W2064621036 hasConceptScore W2064621036C3019040382 @default.
• W2064621036 hasConceptScore W2064621036C3019848702 @default.
• W2064621036 hasConceptScore W2064621036C71924100 @default.
• W2064621036 hasIssue "6" @default.
• W2064621036 hasLocation W20646210361 @default.
• W2064621036 hasLocation W20646210362 @default.
• W2064621036 hasLocation W20646210363 @default.
• W2064621036 hasLocation W20646210364 @default.
• W2064621036 hasOpenAccess W2064621036 @default.
• W2064621036 hasPrimaryLocation W20646210361 @default.
• W2064621036 hasRelatedWork W1592667025 @default.
• W2064621036 hasRelatedWork W2098843574 @default.
• W2064621036 hasRelatedWork W2417550195 @default.
• W2064621036 hasRelatedWork W2417892056 @default.
• W2064621036 hasRelatedWork W2419447267 @default.
• W2064621036 hasRelatedWork W2887403370 @default.
• W2064621036 hasRelatedWork W4226471102 @default.
• W2064621036 hasRelatedWork W4230468811 @default.
• W2064621036 hasRelatedWork W4241163474 @default.
• W2064621036 hasRelatedWork W4245951255 @default.
• W2064621036 hasVolume "87" @default.
• W2064621036 isParatext "false" @default.
• W2064621036 isRetracted "false" @default.
• W2064621036 magId "2064621036" @default.
• W2064621036 workType "article" @default.