End-stage renal disease: Symptom management and advance care planning

Nina R. O'connor, Amy Westcott

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

The prevalence of end-stage renal disease continues to increase, and dialysis is offered to older and more medically complex patients. Pain is problematic in up to one-half of patients receiving dialysis and may result from renal and nonrenal etiologies. Opioids can be prescribed safely, but the patient's renal function must be considered when selecting a drug and when determining the dosage. Fentanyl and methadone are considered the safest opioids for use in patients with end-stage renal disease. Nonpain symptoms are common and affect quality of life. Phosphate binders, ondansetron, and naltrexone can be helpful for pruritus. Fatigue can be managed with treatment of anemia and optimization of dialysis, but persistent fatigue should prompt screening for depression. Ondansetron, metoclopramide, and haloperidol are effective for uremia-associated nausea. Nondialytic management may be preferable to dialysis initiation in older patients and in those with additional life-limiting illnesses, and may not significantly decrease life expectancy. Delaying dialysis initiation is also an option. Patients with end-stage renal disease should have advance directives, including documentation of situations in which they would no longer want dialysis.

Original languageEnglish (US)
Pages (from-to)705-710
Number of pages6
JournalAmerican family physician
Volume85
Issue number7
StatePublished - Apr 1 2012

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Advance Care Planning
Disease Management
Chronic Kidney Failure
Dialysis
Ondansetron
Opioid Analgesics
Fatigue
Kidney
Advance Directives
Naltrexone
Metoclopramide
Uremia
Methadone
Fentanyl
Haloperidol
Pruritus
Life Expectancy
Documentation
Nausea
Anemia

All Science Journal Classification (ASJC) codes

  • Family Practice

Cite this

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End-stage renal disease : Symptom management and advance care planning. / O'connor, Nina R.; Westcott, Amy.

In: American family physician, Vol. 85, No. 7, 01.04.2012, p. 705-710.

Research output: Contribution to journalArticle

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