A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.
2016; 30 (7): 653-660
Epidemiology and Public Health Concerns of CKD in Older Adults
ADVANCES IN CHRONIC KIDNEY DISEASE
2016; 23 (1): 8-11
Pemetrexed-Induced Nephrogenic Diabetes Insipidus.
American journal of kidney diseases : the official journal of the National Kidney Foundation
Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied.Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD.We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis.There were 121 medical director respondents from 28 states.The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions.Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions.
View details for DOI 10.1177/0269216315625856
View details for PubMedID 26814215
Pemetrexed is an approved antimetabolite agent, now widely used for treating locally advanced or metastatic nonsquamous non-small cell lung cancer. Although no electrolyte abnormalities are described in the prescribing information for this drug, several case reports have noted nephrogenic diabetes insipidus with associated acute kidney injury. We present a case of nephrogenic diabetes insipidus without severely reduced kidney function and propose a mechanism for the isolated finding. Severe hypernatremia can lead to encephalopathy and osmotic demyelination, and our report highlights the importance of careful monitoring of electrolytes and kidney function in patients with lung cancer receiving pemetrexed.
View details for DOI 10.1053/j.ajkd.2016.04.016
View details for PubMedID 27241854