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Namirah Jamshed M.B;B.S Associate Professor of Clinical Medicine Georgetown University School of Medicine MedStar Washington Hospital Center ©AAHCM
76 year old AA lady PMH ◦ CKD ◦ CHF ◦ CAD ◦ CVA ◦ HTN ◦ Peripheral neuropathy ◦ DM ◦ Anemia SH ◦ Home/Son ◦ PCA services 14hrs/day Medications ◦ Lantus ◦ Metoprolol ◦ Hydralazine ◦ Furosemide ©AAHCM
~ 44% in ≥ 65 years 60% -69% ≥ 80 years age Stage III 70-77% ↑CHF, CAD, CVA, PVD, HTN Lesley A. Stevens et al. Am J Kidney Dis 55(S2):S23-S33. © 2010 by the National Kidney Foundation, Inc ©AAHCM
Age Comorbidity Functional status Albumin Cognitive impairment ©AAHCM
Glycemic Control ACE inhibitor or ARB therapy Blood Pressure Control Dietary restriction of protein ©AAHCM
Mental Health Disturbance ◦ State of Mind ◦ Cognitive Abilities Falls Multimorbidity management ◦ Willingness or capacity to comply Medication maangement ©AAHCM
Paternelism Beneficence RRT: Default pathway?
What one can to ensure that their wishes and preferences are consistent with the health care treatment they might receive if they were unable to speak for themselves or make their own decisions. http://www.cdc.gov/aging/advancecareplanning/ http://www.cdc.gov/aging/advancecareplanning/ ©AAHCM
Initiate prior to the need for dialysis Include family in discussion Family support Family influence Family involvement Provide detailed information as part of pre- dialysis education Logistics of scheduling and transport ©AAHCM
Typical Illness Trajectories For Chronic Murray S A et al. BMJ 2005;330:1007-1011 ©AAHCM
Moss, Clin J Am Soc Nephrol 3:1379-1384, 2008 ©AAHCM
8% vs 12% survival to hospital discharge 3% vs 9% alive in 6 months Neurolgical compromise or mechanical ventilation Moss AH, Holley JL, Upton MB. Outcomes of cardiopulmonary resuctitation in dialysis patients. J Am Soc Nephrol. 1992;3(6);1238-1243 Expectations ◦ 87% wanted CPR ◦ Blacks > White (OR 6.56, CI 95%) Moss AH, Hozayen O, King K et al. Attitudes of paitens toward cardiopulmonary resucitation in the dialysis unit. Am J Kidney Dis. 2001;38(4):565-568 ©AAHCM
2013 Low albumin Anemia azotemia 2014 ? Twitching; Myoclonus; seizure ©AAHCM
CKD Status Stage Knowledge Prognosis Co-morbid Conditions CVD HTN DM Pyscho-social issues Cognition Support Adherence Burdens of Dialysis Physical Financial Logistics Caregiver Advance Care Planning
Charlotte Carlson, MD, MPH Clinical Geriatrics Fellow University of California at San Francisco AAHCM Annual Meeting, May 14, 2014, Orlando, FL ©AAHCM.
Risk Stratification in Renal Care Mary Jane McKendry Vice President, Operations Fresenius Disease Management Optimal Renal Care.
Renal Replacement Therapy: What the PCP Needs to Know.
The long-term outcome after acute renal failure Presented by Ri 顏玎安.
PREDICTING AKI IS MORE CHALLENGING AS AGE PROGRESSES Sandra Kane-Gill, PharmD, MSc Associate Professor, School of Pharmacy.
Advance Care Planning: Making Preparations in the Event Life Changes Unexpectedly.
Widening the Circles of Inclusion The National Renal Service Dr Donal O’Donoghue Co-Chair Renal Advisory Group 4 July 2006.
Hemoglobin A 1c in Hemodialysis Patients Source: Ix JH. Hemoglobin A1c in hemodialysis patients: Should one size fit all? Clin J Am Soc Nephrol. 2010;5:1539–1541.
Community Health Team Care Management Process PinnacleHealth Systems Don DeArmitt, M.D. Becky E. Zook RN, BSN, MS, CCP.
The Continuum of Advance Care Planning Kathie Supiano, PhD, LCSW Associate Professor University of Utah College of Nursing.
Chapter 2: Identification and Care of Patients With CKD 2014 ANNUAL DATA REPORT VOLUME 1: CHRONIC KIDNEY DISEASE.
1 The Goals of End of Life Care Adapted from:The PERT Program Pain & Palliative Care Research Department Swedish Medical Center, Seattle, Washington Module.
Chronic Haemodialysis therapy in octogenarians with ESRF: demographics and outcomes from a single centre in England Dr Punit Yadav Dr Jyoti Baharani.
1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Community-Based Nursing and Home Care Chapter 6.
Chapter 5: Acute Kidney Injury 2014 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE.
Comorbidity of 10 common conditions Guthrie B et al. BMJ 2012;345:bmj.e6341.
Consultant in Palliative Medicine Calderdale & Huddersfield NHS
Chapter 5: Acute Kidney Injury 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE.
ALLHAT 6/5/ CARDIOVASCULAR DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED BY BASELINE GLOMERULAR FILTRATION RATE (3 GROUPS by GFR)
CHESHIRE & MERSEYSIDE PALLIATIVE AND END OF LIFE CLINICAL NETWORK ADVANCE CARE PLANNING FRAMEWORK PROMOTING CONVERSATIONS AND PLANNING YOUR FUTURE CARE.
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