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Integrating Palliative Care in Kidney Disease Management

The intersection of palliative care and kidney disease management is receiving increased attention, thanks to the efforts of the Center to Advance Palliative Care (CAPC) and the National Kidney Foundation (NKF). A new publication entitled The Case for Palliative Care in Kidney Care reveals significant disparities in treatment for patients suffering from advanced kidney disease compared to those with cancer. In particular, patients facing challenging symptoms—like fatigue, itching, and pain—often slip through the cracks when it comes to receiving adequate pain management and supportive care.

Despite the well-documented prevalence of distressing symptoms among individuals with kidney disease, less than 10% of older adults undergoing dialysis engage in discussions about their treatment goals. This statistic highlights a critical gap in care that must be bridged to enhance the quality of life for those affected. The publication emphasizes the pressing need for palliative care to become an integral part of kidney disease treatment. It calls for nephrology practices, dialysis facilities, and health systems to elevate their palliative care capabilities through clinician training, interprofessional collaboration, and systematic changes that recognize patient-centered outcomes.

The Role of Palliative Care

Palliative care is specialized medical assistance designed for those grappling with serious illnesses. Its core objective is to alleviate symptoms and reduce the stress associated with such conditions, ultimately aiming to enhance the overall quality of life for patients and their families. Specifically regarding kidney disease, palliative care aids in elucidating patients’ values and treatment preferences while also facilitating future healthcare planning.

Research has shown that implementing specialty palliative care for advanced kidney disease can lead to:

• - A 12% reduction in emergency department visits.
• - A 12% decline in hospital admissions.
• - A 41% decrease in ICU admissions.
• - Notable improvements in symptoms for dialysis patients who receive at least one inpatient palliative consult.
• - Enhanced quality of life and diminished feelings of regret surrounding dialysis when discussions about prognosis and care goals are undertaken.

Given the multifaceted nature of kidney disease, patients and families frequently encounter complex treatment choices that provoke emotional and existential distress. Nephrology teams are encouraged to adopt clinical skills that emphasize:

• - The exploration of patient values, preferences, and goals to promote shared decision-making.
• - Addressing emotional and spiritual concerns that arise during treatment.
• - Providing guidance and support for family caregivers through anticipatory counseling.

A Call to Action

Brynn Bowman, MPA, CEO of the Center to Advance Palliative Care, reinforces this message by stating, "This report is a clear call to action. People with advanced kidney disease are navigating difficult decisions, and too many suffer from unrelenting symptoms without the support they need. By making palliative care a fundamental part of kidney care, we can offer compassionate, person-centered support to every patient in every setting."

Joseph Vassalotti, MD, Chief Medical Officer of the NKF, expands on this by clarifying that the essence of palliative care in kidney disease is centered around enhancing quality of life through symptom management, emotional and spiritual support, and enabling families to make informed treatment decisions, irrespective of whether they opt for specific interventions or not.

For more information, you can access The Case for Palliative Care in Kidney Care at capc.org.

About the Organizations

Center to Advance Palliative Care (CAPC)

Founded in 1999, the CAPC is a national nonprofit dedicated to enhancing the availability of equitable and quality healthcare for individuals with serious illnesses. As the leading resource in this field, it equips healthcare professionals and organizations with the necessary training, tools, and technical support to achieve effective care systems.

National Kidney Foundation (NKF)

The NKF revolutionizes the fight against preventable kidney diseases by fostering innovation in patient care and addressing systemic inequities in kidney treatment, dialysis, and transplantation. They aim to ensure dignity and quality of life for patients through comprehensive care solutions.