The ABCs of Renal Palliative Care: Tools for Decision-Making and Symptom Management in Kidney Disease (TH312)

Abstract

1.Describe role of the palliative care consult in the decision making and symptom management of seriously ill patients with kidney disease.2.Discuss the role of prognostication to guide renal providers and patients in decisions of dialysis initiation, withdrawal, and withholding in seriously ill patients.3.Describe a communication framework for the palliative care consultant to assist renal providers, seriously ill patients, and family members in treatment decisions and goals of care. Kidney disease is common among patients facing serious illness. The kidney disease trajectory is unique to other chronic illnesses and carries a high mortality rate which rivals many cancers. The palliative care provider is tasked with caring for this complex population, presenting unique challenges involving symptom management and treatment decision making. The purpose of this session is to describe the role of the palliative care consultant caring for patients with kidney disease, provide prognostic tools, and provide a framework for engaging in discussions of treatment decisions. The session includes an overview of the kidney disease trajectory and describes common triggers for palliative care consultation. Three common triggers for palliative care involvement along this trajectory will be explored and discussed: (a) discussions of dialysis initiation and withholding in seriously ill patients, (b) symptom management and medication strategies for patients both receiving and not receiving dialysis, and (c) end-of-life issues including dialysis withdrawal and dialysis access failure. We present a framework to elicit patient values and goals specifically addressing kidney disease treatment plans. This framework includes communicating the risks and benefits of dialysis in seriously ill patients and negotiating a care plan which may include withholding dialysis, withdrawing dialysis, or a time-limited treatment trial. By the end of the session, the palliative care provider will have gained new tools and understanding in caring for seriously ill patients with kidney disease. Participants will have an understanding of the unique challenges in treatment decision making; be able to list common symptoms patients experience, including treatment-related issues specific to certain symptoms; and gain an understanding of the prognostic factors and outcomes for different treatment paths. The palliative care provider will have the skill set to communicate care goals and treatment decisions with seriously ill patients with kidney disease.