Abstract: PUB201
Palliative Goals of Care With Conservative Treatment of CKD 5 Prolonged Life Up to 24 Months in an Elderly Patient
Session Information
Category: Geriatric Nephrology
- 1200 Geriatric Nephrology
Author
- Bhullar, Jasjot K., Spartanburg Regional Healthcare System, Spartanburg, South Carolina, United States
Introduction
One-fifth of patients on dialysis in the USA and Australia are ≥75years old, and this segment of the population constitutes the fastest growing dialysis age-group. While there is a paucity of data surrounding mortality in elderly patients treated with conservative measures, it is understood that elderly patients are more likely to have greater morbidity, increased frailty, and decreased functional status. For these patients and others, a conservative approach may be optimal.
Case Description
82-year-old female presented to the emergency room in September 2019 with the chief complaint of chest pain. She was found to have CKD stage IV with a serum creatinine of 3.7 at that time. Due to changes on chest Xray and presumed Acute Kidney Injury she underwent aggressive diuresis. Unfortunately, her creatinine worsened. A renal ultrasound at that time showed bilateral atrophy. She was discharged home once stable with outpatient nephrology follow up. Due to weakness and hypertensive urgency, she was rehospitalized in December 2019. By that time, she had progressed to ESRD. The patient and family were hesitant to pursue dialysis and her creatinine and symptoms stabilized, so the decision was made to pursue conservative management of CKD 5.
Assessment and plan as follows:
1. Hyperkalemia—Lokelma
2. Constipation- Milk of magnesium
3. Pain- low dose gabapentin + opioids per pain management
4. Fatigue-
5. Swelling- Torsemide increased to 40mg daily (Oct 2021), then to 40mg bid (Nov 2021)
6. Hyperphosphatemia- Phoslo 667mg tid
7. HTN- Torsemide, Norvasc
8. Vit D deficiency- vit D supplement
Despite multiple kidney-related symptoms for which she is being treated, she has been able to maintain autonomy, quality of life and increased independence due to successful conservative medical management of her ESRD for over 2 years.
Discussion
Symptoms and medical management of CKD 5 is a two pronged approach which can help ease the burden of the nephrology team and the palliative care team while achieving patient oriented outcomes of prolonged and improved quality of life.
Palliative Management Plan:
1. Pain
2. Fatigue
3. Anorexia
4. Nausea and vomiting
5. Pruritis and Restless Leg Syndrome
6. Advanced Care Planning
CKD Medical Management Plan:
1. Volume status
2. Hyperkalemia
3. Metabolic acidosis
4. Anemia of CKD
5. weight loss
6. Hyperphosphatemia and secondary hyperparathyroidism
7. Hypertension