The aging population with chronic kidney disease has called for a paradigm shift in the approach to treatment decision-making. Nephrologists are faced with unique challenges as many elderly patients have accumulated medical and geriatric conditions, and the importance of palliative care in nephrology is gaining increasing attention worldwide.
In a recent AJKD article, Koncicki and Schell provide nephrologists with a guide to support communication and treatment decision-making for elderly patients with advanced kidney disease. The following questions based on the article will test your knowledge on this topic.
Post prepared by Dr. Allison Tong, AJKD Blog Contributor. For a PDF version of the questions & answers, please click here.
1. Palliative care for patients and families living with serious, complex, or life-limiting illness is focused on:
Conservative management (non-dialytic care)
2. The article suggests that “it is important to prepare patients and families that if the decision is to forgo dialysis,” the average survival in patients who withdraw from dialysis is:
3. Which of the following are not included in the criteria for assessing frailty as proposed by Fried et al in 2001
Unintentional weight loss (10 lbs over 1 year)
Slow walking speed
Weakness (grip strength)
4. The Charlson Comorbidity Index (CCI) can be used to estimate prognosis for patients on dialysis. One point is given for every 10 years over the age of 40 years. The highest risk group (CCI ≥ 8) has an estimated 1 year mortality of 49%. Which of the following are worth two points?
Diabetes with end-organ damage
Chronic pulmonary disease
Moderate or severe liver disease
5. Koncicki and Schell
recommend the “Ask-Tell-Ask” framework for disclosing prognostic information. First, is it is helpful to “Ask” the patient what and how they want the information. “Tell” refers to providing information in an accessible manner. What is the maximum number of pieces of information they recommend giving to patients at any one time?