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Symptom management in patients with established renal failure managed without dialysis.
EDTNA ERCA J. 2006 Apr-Jun; 32(2):93-8.EE

Abstract

Increasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non-cancer diagnoses. These symptoms may often go unrecognised and under-treated. Regular symptom assessment is necessary, together with pro-active management of identified symptoms. Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation. Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co-morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients.

Authors+Show Affiliations

Dept of Palliative Care & Policy, Kings College London, UK. fliss.murtagh@kcl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16898102

Citation

Murtagh, F E M., et al. "Symptom Management in Patients With Established Renal Failure Managed Without Dialysis." EDTNA/ERCA Journal (English Ed.), vol. 32, no. 2, 2006, pp. 93-8.
Murtagh FE, Addington-Hall JM, Donohoe P, et al. Symptom management in patients with established renal failure managed without dialysis. EDTNA ERCA J. 2006;32(2):93-8.
Murtagh, F. E., Addington-Hall, J. M., Donohoe, P., & Higginson, I. J. (2006). Symptom management in patients with established renal failure managed without dialysis. EDTNA/ERCA Journal (English Ed.), 32(2), 93-8.
Murtagh FE, et al. Symptom Management in Patients With Established Renal Failure Managed Without Dialysis. EDTNA ERCA J. 2006 Apr-Jun;32(2):93-8. PubMed PMID: 16898102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptom management in patients with established renal failure managed without dialysis. AU - Murtagh,F E M, AU - Addington-Hall,J M, AU - Donohoe,P, AU - Higginson,I J, PY - 2006/8/11/pubmed PY - 2006/9/16/medline PY - 2006/8/11/entrez SP - 93 EP - 8 JF - EDTNA/ERCA journal (English ed.) JO - EDTNA ERCA J VL - 32 IS - 2 N2 - Increasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non-cancer diagnoses. These symptoms may often go unrecognised and under-treated. Regular symptom assessment is necessary, together with pro-active management of identified symptoms. Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation. Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co-morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients. SN - 1019-083X UR - https://www.unboundmedicine.com/medline/citation/16898102/Symptom_management_in_patients_with_established_renal_failure_managed_without_dialysis_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -