Abstract
In South Africa, there is a high burden of end-stage kidney disease (ESKD). This is due to the burgeoning epidemics of communicable diseases like HIV/AIDS and non-communicable diseases, particularly hypertension and diabetes mellitus. One of the most difficult situations encountered by healthcare professionals dealing with patients with ESKD in South Africa is the management of a conservative or palliative care pathway for the many patients who have no other option. Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Many patients are managed in primary healthcare settings and either do not have access to palliative care or are not referred appropriately. Renal supportive and palliative care involves a multidisciplinary approach to managing patients with ESKD, to ensure that symptoms are managed optimally and to provide support during advanced disease. It aims to improve quality of life for patients and their families and must be provided alongside curative medical care. This support should include those unable to gain access to life-saving dialysis and it should also provide care for patients where dialysis is not the best option. The aim of this consensus statement is to assist healthcare providers to improve the management of symptoms and biosocial factors of patients with end-stage kidney disease in a South African context. The document was compiled through consensus building among healthcare professionals across South Africa. The professionals that are represented included nephrologists, palliative care physicians, social workers, nurses, paediatricians and hospital managers. We wish to acknowledge the contribution of Dr Frank Brennan, a leading expert in renal palliative and supportive care, who assisted greatly in the compilation of this document.
Highlights
In South Africa, there is a high burden of end-stage kidney disease (ESKD).This is due to the burgeoning epidemics of communicable diseases like human immunodeficiency virus (HIV)/Acquired immuno-deficiency syndrome (AIDS) and non-communicable diseases, hypertension and diabetes mellitus
In South Africa, the high degree of ESKD is due to burgeoning epidemics of communicable and non-communicable diseases, hypertension and diabetes mellitus
Determine the actual number of patients who require palliative and supportive care due to ESKD
Summary
All members of the care team should be adept at communicating compassionately with the patient and the family in order to break bad news and initiate discussions around withdrawing or withholding artificial nutrition, inappropriate hydration and medically inappropriate investigations or interventions. Paediatric palliative care (PPC) provides an active approach to reduce disease burden and improve quality of life for Suitability for renal replacement therapy both the child and family, through formulation of manage-. In lower- and middle-income countries, psychosocial and ment plans by a multidisciplinary team These plans address economic factors may play a larger role in the selection distressing symptoms in different domains of well-being: 98 criteria, especially where families are responsible for the physical, spiritual, social, cultural and psychological. Active palliative care interventions include symptom management, medical and prognostic counselling, facilitation of family meetings and discussion of ethics, advance care planning as well as difficult discussions about end-of-life care. In cases where important drugs are not available, advocacy may be required to gain access to these agents. Devices for ease of drug administration need to be considered including nasogastric tubes or percutaneous endoscopic gastrostomies (PEGs) inserted for chronic use. May need intravenous access for specific symptoms such as tetany
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