Mr RS observed that he liked his beer and smokes too much and he would decline dialysis. Over the next 4 years Mr RS attended appointments with his nephrologist and the palliative care team. During this
time he was admitted to hospital eight times, for symptom control, hot food and contact with the nursing team. The social worker adjusted living accommodation as Mr RS’s frailty increased. The last days of Mr RS were in a religious hospice at his specific request. In this vignette, the patient was well selleck known to the renal team for many years allowing time for discussions with his nephrologist about what was important in his life. This allowed management of his symptoms, acknowledgement and acceptance of his wish not to dialyse and ensuring that he was able to die in his place of choice. This
case also demonstrates that age should not be seen as an issue. This was a patient who engaged with the team, expressed his wishes and was treated well. His age of 59 was not a deterrent to this pathway. “
“Aim: The aim of this study was to determine whether ankle-brachial index (ABI) predicts the rate of decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. Previous studies demonstrated the importance of loss of RRF in predicting all-cause risk and cardiovascular mortality in PD patients. It is also
known that patients with a low ABI value have a greater risk for deteriorating Target Selective Inhibitor Library high throughput renal function in the general population. The relationship between ABI and the declining rate of RRF in PD patients with an additional dialysis-specific risk factor is uncertain. Methods: Seventy-four PD patients with RRF of more than 1 mL/min per 1.73 m2 were analyzed. ABI was used as the surrogate measure of pre-existing cardiovascular disease and atherosclerosis burden to further determine the outcome of RRF in this study. The slope of decline of RRF was used to determine the selleck chemicals outcome. Results: Based on the multivariate analysis, only ABI (P < 0.001), diabetes (P = 0.02) and baseline RRF (P = 0.009) independently predicted a faster decline in RRF. A stepwise multiple linear regression analysis demonstrated that ABI was an independent predictor for the slope of decline of RRF (P < 0.001). Conclusion: A low ABI is an independent predictor of not only the known atherosclerotic events, but also of the rate of decline of RRF over time in PD patients. "
“Decision-making in clinical practice is complex and getting more complex. There are a large range of alternative actions possible, all with different consequences and trade-offs. The complexity of medical decision-making is best illustrated using a clinical scenario.