Kidney Week

Abstract: SA-PO922

Frequent Home Haemodialysis as “Palliative Dialysis”: Time for a Paradigm Shift

Session Information

• Dialysis: Home Hemodialysis
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 702 Dialysis: Home Hemodialysis

Authors

• Borman, Natalie L., Wessex Renal and Transplantation unit, Hayling Island, United Kingdom

Natalie L. Borman,

• Nair, Sunita, Royal Shrewsbury Hospital, Shrewsbury, United Kingdom

Sunita Nair,

Introduction

Increasingly the profile of dialysis patients has changed from young and fit to older and multi-comorbid. Dialysing these patients is fraught with difficulties due to their comorbidities. Managing such complex patients requires a collaborative approach by Renal and Palliative physicians. A Palliative approach to dialysis embraces the transition from a conventional disease-oriented focus on dialysis as a rehabilitative treatment to an approach prioritizing comfort and alignment with patient goals. Palliative care affirms life, provides symptom relief by integrating medical, psychological and spiritual needs of a patient and considers dying as a normal process. Palliative dialysis as part of palliative medicine is not a well-recognized concept.

Case Description

We describe our experience with six individual patients on Home Haemodialysis (HHD) using NxStage system One, who have benefitted from a palliative approach to dialysis as part of their holistic treatment. Table 1 outlines the patients included.
As outlined in the table, we had patients with variable age and comorbidities who underwent dialysis for symptom control on a palliative basis, either at home or at the hospice. All patients had significant symptom burden and co-existing illness, but wished to continue dialysis at home spending quality time with family. Dialysis was continued in the context of palliation, focusing on symptom control. This also offered flexibility and thereby improved the quality of the final month of life.

Discussion

Palliative care programs result in beneficial effects on symptoms, reduced hospital costs, increase likelihood of death at home, and improve patient and family satisfaction, compared to conventional care. Patients undergoing maintenance dialysis with associated significant comorbidities, a high mortality rate, and possibly co-existing terminal illness could be candidates for a palliative approach to dialysis. It is time to incorporate this as a part of the continuum of renal treatment, providing a patient centered holistic approach.

Table 1