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Chronic Kidney Disease and Advance Care Planning

Tuesday, February 15, 2022

Chronic Kidney Disease (CKD) is a condition characterized by a gradual loss of kidney function through time. Those with CKD may develop complications such as high blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. CKD can progress to end-stage kidney failure, which is fatal without dialysis or a kidney transplant. While individuals on dialysis can improve their quality of life with treatments, individuals with stage 4 kidney disease have a high risk of heart disease which can dramatically decrease life expectancy. 

CKD can be diagnosed at any age, however, there are those who are at increased risk. Individuals at higher risk for kidney disease include those who

  • Have diabetes
  • Have high blood pressure
  • Have a family history of kidney failure
  • Are of advanced age
  • Belong to a population that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians. 

Having these comorbidities increases a person’s chance of needing additional medical  care or developing a terminal illness. In addition, poor communication, and a failure to establish care goals may result in unnecessary hospital admissions, more invasive procedures, and increased distress. 

An important part of comprehensive CKD care is the incorporation of advance care planning (ACP) into the patient’s journey. While ACP is often advocated for those with advanced kidney disease, it is not always implemented. Education regarding ACP and a physician endorsement is often a requirement for an individual’s thorough understanding of the importance of planning his/her future care. 

According to a recent study, individuals with CKD use intensive care when they are hospitalized with a serious condition and die in a hospital more frequently than individuals with cancer or heart disease. ACP can help align treatment with individual preferences and improve individual-centered care, yet ACP quality and experiences between individuals and their caregivers remain misunderstood. 

Even for those individuals with advance directives and surrogate decision makers, there is often a lack of those who actually have detailed conversations stating their preferences for life-sustaining measures with their physician. Why? Because individuals often believe that their physicians understand their end-of-life wishes despite never having had ACP conversations that would make those wishes clear. Further, the individual may believe that their caregiver, surrogate decision maker, or advocate knows their wishes, despite not having anything written and documented. 

Just like with any other serious illness, CKD can advance quickly if not well monitored and treated and as stated, it often isn’t the kidney disease that is the source of death. Documenting treatment preferences, wishes for life-sustaining measures, and other care plans as part of a well planned patient care journey are key. What’s more, documentation is not enough. Conversations with family individuals, physicians, caregivers, and close friends are imperative. This will save any unwanted treatment or heroic measures that may cause unnecessary suffering. 

These conversations are difficult to have and sometimes awkward to begin. At Iris, we take ownership of the entire ACP process and champion the benefits of ACP to your patient individuals and physicians. We take the burden of having these conversations off of the providers and remove the barrier to having these discussions. Our expert healthcare facilitators manage the entire ACP process including individual outreach, in depth ACP  discussions and treatment education, document completion, and distribution of directives to care teams to ensure goal concordant care. If you’re ready to learn more about our customizable and scalable ACP solutions, get in touch with us today. 

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