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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. ©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: ©AAHCM
Moss, Clin J Am Soc Nephrol 3: , 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); 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): ©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
1 Nephrology Care at the End of Life: New Guideline on Withholding and Withdrawing Dialysis Alvin H. Moss, MD, FACP, FAAHPM Section of Nephrology West.
Risk Stratification in Renal Care Mary Jane McKendry Vice President, Operations Fresenius Disease Management Optimal Renal Care.
Hyperphosphataemia in chronic kidney disease Clinical case scenarios Support for education and learning for Children and young peoples renal services March.
End of Life Care for a Person With Parkinson Disease Recent Research and Clinical Implications.
UK Renal Registry 2012 Annual Audit Meeting October 9 th 2012 Dr Aine Burns Consultant Nephrologist Centre for Nephrology Royal Free NHS Foundation Trust.
Right Care for Patients The National Shared Decision Making Programme.
Sharp HospiceCares Transitions Program A New Model for Late Stage Disease Management Daniel R. Hoefer, MD CMO, Outpatient Palliative Care and Hospice Suzi.
Co-Management of Chronic Physical and Behavioral Health Conditions Ruth Shim, MD, MPH Assistant Professor, Department of Psychiatry and Behavioral Sciences.
EBM 2.0 Incorporating values and preferences in clinical decision making Gordon Guyatt CLARITY research group, McMaster University Gordon Guyatt CLARITY.
Living Wills Fiona Crow MD March Where to start? What do we want to achieve? When?
Fostering and Assessing Adherence to Treatment Your name Institution/organization Meeting Date International Standards 9, 17.
CARERS AND DISCHARGE A carers guide to hospital discharge April 2010 Are all the agreed services to support you and the patient in place or do you know.
What is Advance Care Planning?. Advance care planning “A process of discussion between an individual and their care providers irrespective of discipline.
Best Practices in End-of-Life Care Ellen L. Csikai, Ph.D School of Social Work The University of Alabama.
Palliating Congestive Heart Failure – 3 things you need to know Dr. Jana Pilkey MD, FRCPC Internal Medicine, Palliative Medicine Mar 14, 2013.
Peritoneal Dialysis Implementing NICE guidance July 2011 NICE clinical guideline 125.
Eliminating Health Disparities Michael A. Rodriguez, MD, MPH Associate Professor David Geffen School of Medicine at UCLA May 10, 2006.
WRHA Palliative Care Program November 2012 Lori Embleton, Program Director.
Medical Orders for Life Sustaining Treatment (MOLST) Promoting communication and respect for end of life care choices across the continuum of care.
Advance Care Planning Your Personal Health Care Choices Your Nursing Home and TXPEC.
Decision-making at End-of-Life Dr Mary Kiely Consultant in Palliative Medicine Calderdale & Huddersfield NHS Foundation Trust.
Fostering and Assessing Adherence to Treatment Your name Institution/organization Meeting Date International Standard 9.
Cardiovascular Disease in Dialysis and Renal Transplantation Jeffrey Guardino, MD FACC Stanford Hospital Division of Cardiology.
The Palliation of End-Stage Heart Disease Dr. Jana Pilkey MD, FRCP(C) Internal Medicine, Palliative Medicine March 14 th, 2007.
Delivery System Design presenter location Event (LS#1 or an introduction)
Noncommunicable Diseases & Health Promotion NCD Management | March 2014 | 1 | CV NCD Management Dr. Cherian Varghese MD., Ph.D. Senior Medical Officer.
Access to Medical Care for Work-Related Injuries and Illnesses Allard E. Dembe, Sc.D. Associate Professor and Senior Research Scientist Center for Health.
Nursing Home Regulation Kathleen C. Buckwalter, PhD, RN, FAAN Professor of Nursing Emerita, and Co-Director, National Health Law & Policy Resource Center.
Guide to Patient & Family Engagement Insert hospital logo here Care Transitions from Hospital to Home: IDEAL Discharge Planning Training [Hospital Name.
Angela Coulter Director of Global Initiatives June 2012 CO-PRODUCING HEALTH CHANGING RELATIONSHIPS.
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