Renal+Supportive+Care

**HOME** **Renal Supportive Care**

//Introduction //

Renal supportive care is the application of Palliative medicine principles to the care of renal patients. The focus is on improving quality of life through symptom management, psychosocial support and care of the dying patient.

//Symptom management guidelines //

Local guidelines are not yet developed. Helpful resources are available at the St George Hospital Renal Unit webpage - Palliative Care Section

//Choosing the non-dialysis pathway//

Some patients with advanced renal disease may elect not to receive renal replacement therapy. The burden of renal replacement therapy and its impact on quality of life is particularly pertinent for elderly patients, those with functional impairment, poor social supports and multiple comorbid medical conditions. Characteristics signifying a poor prognosis in older patients:
 * High comorbidity scores
 * Marked functional impairment
 * Severe chronic malnutrition
 * Nephrologist would not be surprised at their death (the "surprise" question)

Specific issues to address in informed consent for RRT with older CKD patients:
 * Dialysis may not confer a survival advantage over maximum medical management
 * Life on dialysis entail significant burdens that may detract from QOL
 * It is likely that dialysis will not provide any functional improvement
 * Significant functional decline may occur during the first 12 months on dialysis
 * Choosing not to have dialysis does not mean abandonment by your Nephrologist and their team
 * Palliative care is available regardless of the decision to pursue or forego dialysis
 * Hospice is an appropriate consideration for patients with additional terminal illness

Patient brochure on supportive care: Web resources:
 * Haemodialysis mortality predictor
 * The Kidney End of Life Coalition
 * NSW Health Advanced Care Planning - information for professionals

//Palliative Care Physician referral & Supportive Care Clinic//

This is indicated for management renal outpatients with complex symptoms that require specialist management Dr Katalin Urban is the Palliative Care physician at Concord Hospital who runs the Renal Supportive Care Clinic.

The Renal Supportive care clinic runs every other Wednesday between 1pm and 5pm in the Medical Centre Building, Level 2.

Appropriate indications for referral include:
 * Renal patients with cancer or other terminal conditions
 * Renal patients experiencing symptoms that are difficult to manage, especially pain
 * Patients considering withdrawal from dialysis
 * Patients who have elected a non-dialysis pathway who require additional support

__ Urgent referrals __ should be discussed directly with Dr Urban.

Referrals can be sent to:

Dr Katalin Urban Palliative Care Department, Concord Hospital Phone 9767 6799 Fax 9767 8064

Documents:
 * Referral Form [[file:Renal Supportive Care clinic referral.docx]]
 * Patient Information - Renal Supportive Care Clinic[[file:Renal Supportive Care patient info sheet.docx]]
 * POS-S(Renal) Form[[file:POS_S Renal.pdf]]

//Community palliative care referral//

Patients who require additional support to remain at home can be referred to their local community palliative care service.

Community palliative care services work closely GPs, specialists, community nurses and other health care providers. This service is available 7 days a week and for people living in residential aged care facilities.

Services offered include:
 * Pain management
 * Other symptom management eg dyspnoea, nausea
 * Oncology support
 * Bereavement support.

Referrals should be made through Community Health Access Intake Nursing (CHAIN):

 Phone 1300 722 276  Fax 9767 7026.

CHAIN telephone lines are open 7 days a week, 8:00am - 4:00pm, closed on public holidays. Medical and nursing staff may refer patients to this service.

//Hospice care//

Patients who require short-term specialist inpatient palliative care can be referred to their local palliative care unit. In the Sydney Local Health District this is the Telopea Unit at Canterbury Hospital. Dr Urban provide services at this unit. Admissions are accepted on the basis of clinical need.

All referrals for admission should be discussed with the Palliative Care Physician on call.

Contact the on-call Palliative Care Physician at Canterbury through the switchboard on 9787 0000

//Bereavement service//

Concord Hospital 9767 5656