SciELO - Scientific Electronic Library Online

 
vol.32 issue3Portuguese consensus document statement in diagnostic and management of atypical hemolytic uremic syndromeInterventional nephrology - five years dealing with central stenosis: immediate and long-term results author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

  • Have no similar articlesSimilars in SciELO

Share


Portuguese Journal of Nephrology & Hypertension

Print version ISSN 0872-0169

Abstract

CORREIA, Isabel M  and  RODRIGUES, Anabela S. Transitions of care management in CKD: critical thinking and improving strategies. Port J Nephrol Hypert [online]. 2018, vol.32, n.3, pp.233-244. ISSN 0872-0169.

Chronic kidney disease (CKD) has a high clinical and socioeconomic impact and is often associated with multimorbidity. Improved treatment has allowed an increase in patient survival, but patient life expectancy remainslimited. The disease course has a continuum of lesion, stage and treatment transitions. The focus is often placed on treatment modality, disregarding the course of a CKD patient’s disease. In addition, patient management in transitions of modalities of renal replacement therapy (RRT) can also be a vector for improving clinical outcomes. The transition between different types of CKD treatment and the transition of care from paediatric to adult team are critical processes throughout the life of a CKD patient. In the therapeutic transition, there is the need to identify better predictors of success in allocating patients with stage 5 CKD to their first dialytic modality in. There is a risk of early mortality in the induction period of dialysis, particularly of the elderly in extracorporeal dialysis regimens. Doubt remains in decision making about the ideal timing to establish the transition to renal replacement therapy and its most appropriate type. Transfer between dialytic modalities also calls for opportune and integrated policies protecting vascular resources. Renal transplantation is considered the optimal renal replacement therapy; however, transplant failure or the side effects of immunosuppression are threats to consider, which may redirect these patients back to dialysis and involves a re-evaluation of the patient’s status. Also, end-of-life care and decision making between initiating renal replacement therapy or maintaining conservative management are a challenge in the elderly. This review identifies the main challenges in these transitional processes, raising awareness of areas in need of improvement in patient care. The aim should be to achieve a more comprehensive and appropriate health management than a limited focus on CKD modality treatment.

Keywords : Chronic kidney failure; Renal replacement therapy; Conservative non-dialytic treatment; Quality of life; Transitional care; Continuity of patient care.

        · text in English     · English ( pdf )

 

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License