Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Oct 2007
ReviewBegin with the end in mind: the value of outcome-driven nephrology social work.
The last decade has brought multiple changes in the delivery of care to patients with chronic kidney disease (CKD), and the nephrology social worker, like other members of the dialysis care team, has changed in response to a new health care climate. This article reviews a disease course perspective of CKD and the outcome-driven nephrology social work model of practice. The outcome-driven model is strategic and works toward improving patient outcomes. ⋯ Measurement is the key to refining interventions to meet patient and clinic needs. Once an intervention is fine tuned, it can become a standard intervention in a "tool kit" that can be used by the social worker on micro- and macrolevels. This model of nephrology social work practice can improve treatment outcomes in areas such as depression management, fluid management, care planning, missed treatments, rehabilitation, satisfaction with care, and reduced hospitalizations.
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Adv Chronic Kidney Dis · Oct 2007
ReviewPalliative care in end-stage renal disease: illness trajectories, communication, and hospice use.
Palliative care is comprehensive, interdisciplinary care focusing on pain and symptom management, advance-care planning and communication, psychosocial and spiritual support, and, in end-stage renal disease (ESRD), the ethical issues in dialysis decision making. End-of-life care is one aspect of palliative care and incorporates all of the previously mentioned components as well as hospice and bereavement care. ESRD patients and their families are appropriate candidates for palliative care because of their high symptom burden, shortened survival, and significant comorbidity. ⋯ Although communication is an integral component of palliative care, little is understood about effective provider-patient communication, especially in estimating and discussing prognosis. Palliative care has much to offer toward improving the quality of dialysis patients' lives as well as planning for and improving the quality of their deaths. The palliative care issues of illness trajectory, communication, and hospice use among ESRD patients will be reviewed.
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Adv Chronic Kidney Dis · Apr 2007
ReviewHistorical perspective of pregnancy in chronic kidney disease.
Preeclampsia was first recognized as a cause of proteinuria unique to pregnancy in 1843 and the risk of pregnancy in women with preexisting renal disease was noted in the 1930s. Since then, we have recognized that the majority of women with kidney disease who become pregnant have surviving infants. ⋯ Dialysis patients conceive infrequently and have a high frequency of fetal loss and neonatal death. Fertility is restored by renal transplant and guidelines are being developed regarding the ideal timing of pregnancy, the kidney function required for a safe pregnancy, and the use of immunosuppressive drugs in pregnancy.
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Hypertensive disorders of pregnancy are the most common medical disorders of pregnancy and are associated with increased maternal and perinatal risks. The pathophysiology, diagnosis, and treatment are herein reviewed for chronic hypertension, preeclampsia, gestational hypertension, and severe hypertension. The benefits and risks of treating mild, moderate, and severe hypertension are discussed. ⋯ Women may remain hypertensive for a period postpartum and require treatment for a short interval. Early or severe preeclampsia warrants workup postpartum for secondary causes. Pregnancy induced hypertension or preeclampsia are emerging as risk factors for future cardiovascular risk.