The illness trajectory in the last year of life in advanced (stage 5) chronic kidney disease is poorly understood. A person with stage 5 chronic kidney disease has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 ml/min or less. Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM.
CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival.
Symptoms that can occur in stage 5 CKD include:
Changes in Symptoms and Other Concerns between Baseline and the Month before Death
Table 2 provides details of the change in symptoms between baseline and the month before death. Levels of global symptom distress (MSAS-SF GDI) increased, as did both physical and psychologic symptoms, although the latter were more marked. The number of symptoms reported also increased. Concerns beyond symptoms (core POS) also increased notably between baseline and the month before death (Table 3). This was mediated largely by increased anxiety, low mood, family anxiety, and increased information needs and practical concerns.
Dialysis treatments for people with stage 5 CKD
Most people report feeling much better once they begin dialysis. As the toxins are removed from the blood medicines replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life. There are two types of dialysis treatments for people with stage 5 kidney disease.
Hemodialysis: This treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.
kidneyfight@hotmail.com
CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival.
Symptoms that can occur in stage 5 CKD include:
- Loss of appetite
- Nausea or vomiting
- Headaches
- Being tired
- Being unable to concentrate
- Itching
- Making little or no urine
- Swelling, especially around the eyes and ankles
- Muscle cramps
- Tingling in hands or feet
- Changes in skin color
- Increased skin pigmentation
Changes in Symptoms and Other Concerns between Baseline and the Month before Death
Table 2 provides details of the change in symptoms between baseline and the month before death. Levels of global symptom distress (MSAS-SF GDI) increased, as did both physical and psychologic symptoms, although the latter were more marked. The number of symptoms reported also increased. Concerns beyond symptoms (core POS) also increased notably between baseline and the month before death (Table 3). This was mediated largely by increased anxiety, low mood, family anxiety, and increased information needs and practical concerns.
Dialysis treatments for people with stage 5 CKD
Most people report feeling much better once they begin dialysis. As the toxins are removed from the blood medicines replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life. There are two types of dialysis treatments for people with stage 5 kidney disease.
Hemodialysis: This treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.
kidneyfight@hotmail.com
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