Kidney support
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Kidney Support: Comprehensive Insights and Approaches
Kidney Supportive Care: Principles and Practices
Kidney supportive care integrates palliative medicine principles to alleviate suffering in patients with kidney disease through symptom management, empathetic communication, and psychosocial support. This care is provided by nephrology teams and, for complex cases, by an interprofessional specialty palliative care team, which may include physicians, nurses, social workers, chaplains, and dieticians. This approach is applicable to patients with acute kidney injury (AKI) or chronic kidney disease (CKD), including those undergoing kidney replacement therapy (KRT) such as dialysis and transplantation.
Supportive Care in End-Stage Kidney Disease
Supportive care is crucial for patients with advanced kidney disease, aiming to improve quality of life alongside life-prolonging therapies like dialysis. This care should be integrated into the treatment plans for patients with advanced CKD, those receiving KRT, and those opting for non-KRT conservative care. Key themes include improving prognostic information, developing context-specific evidence, establishing care metrics, clear communication of supportive care roles, and integrating supportive care into existing healthcare infrastructures.
Decision Support for Advanced Kidney Disease
A decision support intervention called OPTIONS has been shown to help older patients with advanced kidney disease make informed treatment choices. This intervention significantly improved patients' knowledge about the benefits and risks of dialysis, facilitating shared decision-making and enhancing patient autonomy.
Timing of Kidney Support Therapy in Acute Kidney Injury
The timing of kidney support therapy (KST) in critically ill patients with AKI remains controversial. While some studies suggest benefits from earlier initiation, others show no significant differences in mortality. Decisions on KST initiation should be individualized based on patient comorbidities, illness severity, kidney function trajectory, urine output, and fluid balance needs.
Psychosocial Support for Caregivers
Enhanced psychosocial support for caregivers of patients with chronic kidney failure can significantly reduce caregiver burden and anxiety. This support includes counseling and psychosocial interventions provided by palliative care nurses and social workers, demonstrating early significant reductions in caregiver burden and anxiety.
Renal Support and Multiple Organ Support Therapy
Renal support involves administering renal replacement therapy (RRT) with appropriate timing and indications, tailored to individual patient needs. Advances in extracorporeal treatments now allow support for multiple organs beyond isolated kidney failure. However, the optimal management of severe AKI remains controversial, with no established standard of care.
Economic Considerations in Kidney Supportive Care
Economic considerations are vital in kidney supportive care, which focuses on improving quality of life and aligning treatment with patient goals. Evidence suggests that kidney supportive care can reduce high costs associated with unwanted hospitalizations and intensive treatments. However, more research is needed to evaluate its cost-effectiveness comprehensively.
Nutritional Support in Chronic Kidney Disease
Nutritional support is crucial for patients with CKD, who are at high risk of malnutrition. Admission kidney function is a strong predictor of the effectiveness of nutritional support, with patients having lower eGFR showing the most significant mortality benefits from nutritional interventions.
Clinical Decision Support Systems for Kidney-Related Drug Prescribing
Clinical decision support systems (CDSSs) can improve kidney-related drug prescribing by aiding in the appropriate initiation, modification, monitoring, or discontinuation of drug therapy. Both computerized and manual CDSSs have shown significant improvements in clinician prescribing outcomes and patient-important outcomes, such as reduced adverse drug events.
Social Support and Chronic Kidney Disease
Social support is a critical, yet understudied, factor in managing chronic illnesses, including end-stage renal disease (ESRD). Increased social support can improve outcomes by reducing depressive symptoms, enhancing quality of life, increasing healthcare access, and improving compliance with therapies. Higher levels of social support have been linked to better survival rates in patients with renal disease.
Conclusion
Kidney support encompasses a wide range of interventions aimed at improving the quality of life for patients with kidney disease. From supportive care and decision support interventions to nutritional and psychosocial support, these approaches are essential for comprehensive kidney care. Integrating these strategies into existing healthcare infrastructures and tailoring them to individual patient needs can significantly enhance patient outcomes and reduce healthcare costs.
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