Yin and yang… peanut butter and chocolate… Astaire and Rogers… palliative care and dialysis?

Today’s workshop on this topic (palliative care and dialysis, that is), moderated by yours truly and expertly discussed by Woody Moss, Manjula Kurella Tamura, and Tracy Greene Mintz, was an interactive, case-based look at how the traditional model of separation of ‘aggressive care’ and ‘palliative care’ is being supplanted by a model in which dialysis initiation (aggressive care) can be a pivotal moment when relevant prognostic information can be conveyed and palliative options can be initiated alongside dialysis, particularly in older adults.  We were fortunate to have an audience with nurse practitioners, social workers, physician assistants, and palliative specialists as well as nephrologists, and were able to debate the approach to a set of dilemmas in this area.  Woody reviewed the RPA guideline on shared decision making — apparently, only 10-15% of physicians even know this exists — and Manju reviewed important prognostic information from large studies.  We were reminded by Tracy that numerically old people may not view themselves as ‘old’, and that even a statistic like ‘93% mortality’ may be heard as ‘7% survival’ by the patient and family.  Looking at the increasing number of publications on dialysis in the elderly, I personally think the toolkit provided by RPA (look up RPA SDM for the iPad app) will become a greater part of our daily practice in the next few years in helping older patients navigate stage V CKD and ESRD.

Post written by Dr. Dena Rifkin, Feature Editor for AJKD’s In a Few Words.

Check out more eAJKD coverage of the NKF’s 2014 Spring Clinical Meetings!