RESUMEN
OBJECTIVES: For many people with advanced kidney disease, their physical, psychological and emotional needs remain unmet. Kidney supportive care, fully integrating specialist kidney and palliative care teams, responds to the emotional and symptom distress in this cohort who may be on a non-dialysis care pathway or on dialysis and approaching end of life. We aimed to analyse and describe the operation and patient characteristics of a new kidney supportive care programme (KSCp). METHODS: A multidisciplinary KSCp was introduced through a tertiary hospital in Brisbane, Australia. Operational information and characteristics of referred patients were collected from internal databases and electronic medical records and analysed descriptively. Patient data were collected using validated instruments to assess symptom burden, health-related quality of life, health state, functional status and performance at clinic entry and analysed descriptively. RESULTS: 129 people with advanced kidney disease were referred to the KSCp within the first year (median age 74 (range 27.7-90.5), 48.1% female, median Charlson Comorbidity Index score 7 (IQR 6-8) and mean Integrated Palliative care Outcome Scale Renal score 19.6±9.8). 59% were currently receiving dialysis. The leading reason for referral was symptom management (37%). While quality of life and health state varied considerably among the cohort, in general, these parameters were well below population norms. CONCLUSIONS: Results indicate that patients referred to the KSCp were those with a strong need for a patient-centred, integrated model of care. Shifting focus to co-ordinated, multidisciplinary care rather than discrete specialty silos appears key to addressing the challenging clinical problems in end-of-life care.
RESUMEN
Case 1. The Distressed Health Care Provider Mr MF was a 72 yo married father living independently with his wife. Mr MF was admitted electively for non-operative correction of a known left renal artery stenosis. Previous investigations reported two small kidneys with total obstruction of the right renal artery and > 60% obstruction of the left. Recent health was compromised by multiple admissions to Coronary Care (CCU) with chest pain and acute pulmonary edema (APO) despite recent plasty of a blocked coronary graft, placed in 2002. An Interventional Radiologist accessed the left renal artery. Unfortunately the tip of the catheter guide wire snapped off in the proximal part of the vessel, totally occluding it. An Interventional Cardiologist was unable to retrieve the remnant wire via a brachial approach. The entry site at the right brachial artery puncture developed a hematoma. The Vascular Surgeons opined that open revascularisation of the blocked renal artery was not an option.