ROCKVILLE, Md.—The Renal Physicians Association (RPA) has released a new edition of its guidelines to help doctors and kidney disease patients share decision making about treatment options.
Dr. Alvin (Woody) Moss presented the recommendations included in the Renal Physicians Association (RPA) 2nd edition of its Clinical Practice Guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis at the association's annual meeting in Washington, D.C., in mid-March.
Pain is often under recognized and under treated in dialysis patients, and dialysis may not provide a survival advantage for some patients. Included in the guideline are 19 recommendations for quality in decision-making and treatment of patients with acute kidney injury, chronic kidney disease (CKD), and end-stage renal disease (ESRD) or kidney failure. More than 26 million Americans have CKD and more than 400,000 have ESRD.
The guideline recognizes the communication challenges in discussing prognosis and treatment options with CKD and ESRD patients and their families and provides strategies to assist nephrologists with it. Kidney patients may have distinctly different treatment goals based on their overall condition and preferences: 1) patients may choose aggressive therapy with dialysis without limitations on other treatments; 2) patients with a poor prognosis may choose dialysis but with limitations on other treatments such as cardiopulmonary resuscitation, intubation, and mechanical ventilation because they want to balance life prolongation and comfort; and 3) patients may decline dialysis and prefer that the primary goal of their care be their comfort. The guideline recognizes these important distinctions and the need for open discussion.
"The guideline has been enthusiastically endorsed by physicians, nurses, social workers, patients, and families because it provides evidence-based information about how well particular patients are likely to do on dialysis and assists them to make decisions about starting, continuing, and stopping dialysis based on their values and overall condition,” according to Moss.
Moss also noted that the guideline includes new recommendations with regard to effective pain and symptom management and referral to hospice for patients with advanced illness.
The guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis has been endorsed by 13 organizations. It is available at www.renalmd.org/End-Stage-Renal-Disease.
