CKD and palliative care in the hospital

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Today, Blue Heron Health News provides a variety of remedies for different kinds of illnesses. All of their remedies are natural and safe, so they can be used by anyone regardless of their health condition. Countless articles and eBooks are available on their website from Christian himself and other natural health enthusiasts, such as Julissa Clay , Shelly Manning , Jodi Knapp and Scott Davis.

Hospital-based chronic kidney disease (CKD) and palliative care is a multidisciplinary process to improve the quality of life for patients with end-stage CKD who are not likely to benefit from vigorous treatments like dialysis or kidney transplantation. Palliative care intends to manage symptoms, address the emotional and psychological needs of the patient, and provide support to the patient as well as the family. This type of care can be crucial for CKD patients with end-stage kidney disease (ESKD) or those who have made a deliberate decision not to adhere to dialysis or other life-prolonging treatments.

Key Components of Hospital Palliative Care for CKD Patients:
1. Symptom Management
Pain Relief: Pain is ubiquitous among CKD patients, particularly at higher levels of disease. Palliative care addresses the management of pain by medication such as opioids (with careful monitoring due to the risk of accumulation at damaged kidneys), NSAIDs, or other analgesics.

Fatigue: Fatigue is a hallmark symptom in CKD. The palliative care team engages the patient in measures to control energy, minimize excessive fatigue, and maximize the patient’s ability to perform daily activities.

Nausea and Vomiting: Due to waste buildup in the body (uremia), patients with CKD may experience nausea and vomiting. Palliative care may include medication to manage nausea and improve comfort.

Shortness of Breath: Respiratory distress is apparent in CKD, especially with heart failure. Shortness of breath (dyspnea) can be treated with diuretics to remove excess fluid or opiates to relieve the sensation of breathlessness.

Itching (Pruritus): Uremic pruritus is a common and discomforting symptom in CKD patients. Palliative management can involve antihistamines, topical treatment, or other interventions to relieve itching.

2. Psychosocial and Emotional Support
Depression and Anxiety: Depression, hopelessness, or anxiety is frequent in patients with advanced CKD. Counseling, emotional support, and, where appropriate, medication are provided in palliative care to treat mental health issues.

Advanced Care Planning: The palliative care teams assist in facilitating the discussion about the patient’s care goals. This involves deciding whether or not to undergo dialysis, to pursue conservative management, or to convert to comfort-focused care. The decisions must be made in line with the patient’s preferences, quality-of-life considerations, and prognosis.

Communication: Clear communication between the patient, their caregivers, and medical providers is necessary. Palliative care clinicians facilitate conversations regarding prognosis, treatment, and whether or not dialysis is appropriate, making sure that the patient’s preference is determined and honored.

3. Meeting Family and Caregiver Needs
Education: Palliative care involves instructing the family of the patient on the process of disease, palliative care objectives, as well as alternatives of symptom relief and decision making.

Caregiver Support: Caring for a CKD patient, especially in the terminal stages of the illness, can be physically and emotionally stressful for relatives. Palliative care teams offer caregiving advice, relief care, and emotional and psychological support to the family.

Bereavement Support: Terminal CKD has palliative care extended to the family during the grieving process following the death of the patient. Bereavement support services are provided to help family members cope with bereavement.

4. Conservative Kidney Management
Non-Dialysis Care: For those patients who do not choose dialysis, palliative care is directed toward conservative management of the kidneys. This involves symptom management, optimizing comfort, and addressing complications without the need for invasive procedures. Medications, dietary treatment, and fluid restriction are managed based on the patient’s residual renal function.

Hydration and Nutrition: It is challenging to maintain proper hydration and nutrition in advanced CKD. The palliative care teams work with dietitians to ensure the patient receives sufficient nutrition that does not excessively burden the kidneys.

Complications Management: Electrolyte imbalance, fluid overload, and cardiovascular complications are prevalent among CKD patients. Palliative care provides interventions to minimize these complications, alleviating the discomfort of the patient and enhancing their quality of life.

5. Ethical Problems and Decision-Making
End-of-Life Choices: As CKD progresses to end-stage renal disease, life-sustaining treatment choices, such as dialysis, become more complex. Palliative care teams have a critical role in helping the patient and family make these decisions by clarifying the benefits and burdens of dialysis and other treatments.

Do Not Resuscitate (DNR) Orders: Resuscitation and the delivery of life-sustaining interventions in terminal CKD patients are typically decided with consultation from the patient and family. Palliative care teams support patients and families in aligning treatment decisions with their values and end-of-life care goals.

6. Hospice Care
End-of-Life Care: Once dialysis is not feasible, or a CKD patient elects to focus only on comfort, hospice care may begin. Hospice provides end-of-life specialized care for those at the end of their life, providing a supportive system for the patient and family.

Pain and Symptom Management: Hospice centers on pain and symptom management, keeping the patient comfortable. This may include pain management, nausea, shortness of breath, and other symptoms that the patient is having.

24/7 Care: Hospice provides constant care to patients and families, most commonly in home care or hospice facility care, depending on the needs of the patient.

7. Multidisciplinary Approach
Collaboration: The palliative team has close working relationships with nephrologists, nurses, dietitians, social workers, chaplains, and other specialists to provide integrated care. Through collaboration, all aspects of the patient’s physical, emotional, and spiritual needs are addressed.

Regular Reassessment: Since CKD may evolve over time, ongoing reassessment of the patient’s symptoms, prognosis, and care goals is essential. The palliative care team ensures that the care plan is modified to include changing needs.

Goals of Palliative Care in CKD:
Improve Quality of Life: Prioritize minimizing suffering and maximizing the patient’s comfort on a daily basis.

Align Care with Patient’s Preferences: Ensure that treatment decisions are aligned with the patient’s values and goals, whether that is to pursue dialysis or comfort care.

Provide Comprehensive Support: Deliver physical, emotional, social, and spiritual support to the patient and family.

Manage Symptoms and Complications: Effectively manage the symptoms of CKD, such as pain, nausea, and fatigue, as well as complications such as fluid overload and electrolyte disturbances.

Offer End-of-Life Planning: Counsel patients and families through difficult end-of-life decisions, so the care is in line with the patient’s values.

Conclusion
Hospital-based palliative care for patients with CKD is focused on improving comfort, control of symptoms, and support for the patient and family as they confront the complexities of advanced kidney disease. It is an essential aspect of end-stage CKD patient care or those who opt not to receive dialysis, so they could enjoy the best possible quality of life while they are still alive. By managing physical, emotional, and psychological needs, palliative care is an integral aspect of providing holistic, compassionate care to CKD patients.
Fluid balance is a crucial component of managing patients with chronic kidney disease (CKD) because kidney function plays a critical role in keeping the body’s fluid status intact. CKD undermines the kidneys’ ability to filter and rid the body of excess fluid, leading to potential complications such as edema, hypertension, and electrolyte imbalances. Appropriate fluid balance management can avert hospitalization and improve overall health in patients with CKD. Following is a step-by-step description of fluid balance in patients with CKD and how it should be managed.

1. Fluid Balance in CKD
Fluid balance is the balance between intake and excretion of fluids in the body. In healthy individuals, the kidneys excrete excess fluid, excrete waste products, and regulate electrolytes to maintain homeostasis. But in CKD, this process is disrupted and therefore there are several challenges:

Decreased Kidney Function: As CKD gets worse, the kidneys are less able to remove waste and excess fluid. Fluid accumulates in the body, leading to swelling (edema), shortness of breath (due to fluid accumulation in the lungs), and high blood pressure.

Electrolyte Imbalances: CKD also affects the kidney’s capacity to balance electrolytes like sodium, potassium, and phosphate. These electrolyte imbalances can lead to potentially fatal conditions like hyperkalemia (high potassium) or hyponatremia (low sodium).

Sodium and Water Retention: Patients in early stages of CKD may experience mild fluid retention, but as the disease progresses, it increases due to impaired glomerular filtration rate (GFR). The kidneys are able to retain sodium, leading to water retention and blood volume expansion.

2. Complications of Fluid Imbalance in CKD
Fluid imbalance in CKD can lead to a number of complications that will worsen kidney function and necessitate hospitalization:

Edema: Fluid retention typically manifests as swelling of the feet, ankles, legs, or face. Painful edema and impaired mobility can also occur in severe cases.

Hypertension: Overload of fluid can increase blood pressure, causing further kidney damage. Hypertension is both a cause and a consequence of CKD and creates a vicious cycle that fuels kidney disease progression.

Heart Failure: Fluid accumulation over a period of time may lead to pulmonary edema and cause difficulty in breathing and put the patient at risk for heart failure, especially in patients with underlying cardiovascular disease.

Electrolyte Disturbances: Fluid imbalance may lead to adverse change in the concentration of necessary electrolytes like potassium, which can lead to cardiac arrhythmia, and sodium, which can lead to confusion, seizure, and coma.

3. Factors Affecting Fluid Balance in CKD Patients
Several factors influence fluid balance in patients with CKD, and an understanding of these factors is key to successful management:

Glomerular Filtration Rate (GFR): The lower the GFR, the more impaired the kidneys’ ability to filter blood and excrete excess fluid and waste. The greater the degree of CKD, the more fluid is retained.

Dietary Intake: Sodium intake plays an important role in fluid retention. Fluid retention increases with a high-sodium diet, and a low-sodium diet can avoid or alleviate edema. Intake of fluids should also be regulated especially for patients who are further along in CKD.

Medications: Diuretics or “water pills” are commonly prescribed to help with removal of excess fluid. However, these must be used carefully to avoid dehydration or electrolyte imbalance. Some medications, like ACE inhibitors or ARBs, also help with fluid balance by decreasing proteinuria and blood pressure control.

Cardiovascular Health: CKD patients often also have underlying cardiovascular disease which can complicate fluid imbalance. Successful management of heart disease, e.g., with medications to control fluid and blood pressure status, is important.

Dialysis: Dialysis (hemodialysis or peritoneal dialysis) typically is required in patients with end-stage CKD to remove the excess fluid and waste from the body. How often dialysis is done and how much fluid is removed should be closely regulated to maintain fluid balance.

4. Fluid Balance Management in CKD Patients
Some of the key fluid balance management practices in CKD patients are as follows:

1. Dietary Changes
Sodium Restriction: Reducing sodium intake is crucial to help control fluid retention and blood pressure. CKD patients are usually advised to eat less than 2,000 mg of sodium daily, depending on CKD stage and personal needs. This can help prevent fluid buildup and reduce the kidneys’ workload.

Fluid Intake Management: Fluid intake can need to be restricted in those with severe fluid retention. Fluid intake guidelines vary based on CKD stage but one typical prescription is approximately 1.5 to 2 liters a day. Dialysis patients with end-stage renal disease (ESRD) can sometimes be placed on more stringent fluid restrictions to prevent overload.

Potassium and Phosphorus Management: Potassium and phosphorus content must be carefully monitored in CKD. Potassium-rich (e.g., bananas, oranges, tomatoes) and phosphorus-rich (e.g., dairy, nuts) foods may need to be limited to prevent detrimental imbalances.

2. Medications and Diuretics
Diuretics: Diuretics such as furosemide (Lasix) are beneficial for CKD patients to manage fluid overload. Diuretics enhance urine production and help in excess fluid removal. Diuretics should be used cautiously because overuse leads to dehydration, electrolyte imbalance, and kidney damage.

ACE Inhibitors and ARBs: They not only decrease blood pressure but also possess protective mechanisms in the kidneys through proteinuria reduction (protein in urine), which is common in CKD. By improving kidney function, these medications may be able to prevent fluid accumulation.

Phosphate Binders: In advanced phases of CKD, phosphate binders may be prescribed to control phosphate levels, reducing the likelihood of bone mineral disorders and fluid overload.

3. Monitoring and Adjusting Dialysis
Hemodialysis: Hemodialysis is a valuable treatment for individuals with established CKD or ESRD to manage fluid balance. Dialysis removes excess fluid and waste substances from the body. Dialysis frequency and time are tailored to the patient after careful consideration of fluid removal to avoid hypotension or dehydration.

Peritoneal Dialysis: Peritoneal dialysis is also an option in certain CKD patients. It uses the patient’s peritoneum (lining of the abdominal cavity) to filter out waste and excess fluid. Fluid balance management in peritoneal dialysis includes monitoring dwell time and dialysate volume.

4. Monitoring Weight and Symptoms
Daily Weight Check: Weight checking is one of the easiest and most useful methods of evaluating fluid retention. A rapid weight increase (e.g., 2–3 kg per day) can be a sign of fluid overload, and may necessitate changes in treatment or medication.

Checking Edema: Patients must be checked routinely for edema (swelling), especially in the legs, ankles, and face. Swelling may be an early sign of fluid imbalance.

Symptoms of Pulmonary Edema: Dyspnea, crackles upon lung examination, or orthopnea (breathing discomfort in a recumbent position) are manifestations of pulmonary edema and must be addressed urgently by a medical professional.

5. Patient Education and Self-Management
Patient Education: CKD patients should be instructed in the importance of fluid balance and its impact on kidney function. This should include an understanding of sodium, fluid, and potassium’s function in managing CKD and the consequences of fluid overload.

Empowering Self-Management: Patients should be empowered to monitor fluid intake, weight, and symptoms themselves and inform their healthcare provider early if any significant changes occur.

5. Key Points to Take Away from CKD Fluid Balance
Preventing Fluid Overload: Optimal control of sodium intake, fluid balance, and diuretics must be ensured to prevent fluid overload and associated complications.

Routine Monitoring: Routine monitoring of kidney function, electrolytes, and weight is essential to optimize fluid management protocols.

Dialysis: For those with severe CKD, dialysis must be used to sustain effective fluid balance.

Patient Education: Patients need to be involved in their care, valuing the importance of fluid balance and being vigilant for early warning signs of complications.

Through controlling these areas of fluid balance, CKD patients can avoid complications such as edema, hypertension, and heart failure, improving their quality of life and reducing the risk of hospitalization.

The Chronic Kidney Disease Solution™ By Shelly Manning It is an eBook that includes the most popular methods to care and manage kidney diseases by following the information provided in it. This easily readable eBook covers up various important topics like what is chronic kidney disease, how it is caused, how it can be diagnosed, tissue damages caused by chronic inflammation, how your condition is affected by gut biome, choices for powerful lifestyle and chronic kidney disease with natural tools etc.

Blue Heron Health News

About Christian Goodman

Christian Goodman is the CEO of Blue Heron Health News. He was born and raised in Iceland, and challenges have always been a part of the way he lived. Combining this passion for challenge and his obsession for natural health research, he has found a lot of solutions to different health problems that are rampant in modern society. He is also naturally into helping humanity, which drives him to educate the public on the benefits and effectiveness of his natural health methods.

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