Send the link below via email or IMCopy
Present to your audienceStart remote presentation
- Invited audience members will follow you as you navigate and present
- People invited to a presentation do not need a Prezi account
- This link expires 10 minutes after you close the presentation
- A maximum of 30 users can follow your presentation
- Learn more about this feature in our knowledge base article
Do you really want to delete this prezi?
Neither you, nor the coeditors you shared it with will be able to recover it again.
Make your likes visible on Facebook?
Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.
Palliative Renal Medicine
Transcript of Palliative Renal Medicine
65F eGFR 5
HT, chol, IHD, PVD
Survival 65-74y (95% CI)
1y 85 (84-86)
2y 61 (60-63)
5y 39 (37-41)
T2 Diabetes 50%
Cause of death
Vascular & Misc 18%
Stage IIIC 44%
Grace et al Nephrology 2012
772 Tx in Australia in 2009
59 Tx in >65y
Events, dialysis, diabetes
Blood pressure, weight, fluid assessment
Blood results (find results)
Medication review and scripts
How do you feel?
What if >75y
Palliative Medicine Principles
Applied to Renal Patients
Focus on QOL
Care of the dying patient
Prevalent & troublesome
Update on mechanisms
Complex aetiology & interactions
Who doesn't benefit from dialysis?
Comparative Survival Data
Cost of dialysis
Separating itch from pain
multiple mu-opioid receptors (MORs)
MOR1D KO rats
Anti-histamine sensitive v insensitive itch
Unmyelinated C-fibres eg mosquito bites
Myelinated A-fibres eg Cowage
Chen et al. Cell 2011
Ringkamp et al. J Neuroscience 2011
ITCH National Registry Investigators
Itch daily or nearly daily in >80%
Moderate or extreme UP in 42%
Ongoing for >1y in 60%
Correlation with HR-QOL measures
Mathur VS, et al. A longitudinal study of uremic pruritis in hemodialysis patients. CJASN 2010
Broadband UV B
Beware alternative diagnosis!
Predicting survival ...
HD mortality predictor
Coronary artery disease
Moderate LV dys
Dialysis via vascath
New starters (all comers)
The raw numbers
Estimated 5YS >80%
Murtagh NDT 2007
Carson CJASN 2009
St George Renal Supportive Care Clinic
The best model?