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Beyond the Guidelines - Management Options for an Older Adult With Advanced Chronic Kidney Disease and Dementia
Grand Rounds Discussion From Beth Israel Deaconess Medical Center
The Kidney Disease Outcomes Quality Initiative recommends that patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2 be educated about options for both renal replacement therapy, including dialysis or transplantation, and conservative management. Here, 2 experts—a nephrologist and a general internist–palliative care physician—reflect on the care of a patient with advanced chronic kidney disease (CKD) and mild to moderate dementia. They discuss the management options for patients with advanced CKD, the pros and cons of each method, and how to help a patient choose among them.
- Watch the interview of the patient's daughter.
- What are the options for management of the patient's kidney disease?
- What are the relative pros and cons of dialysis and conservative management? What does each involve?
- What symptoms are more likely to be alleviated with dialysis than conservative management? At what potential price?
- How would you engage in shared decision making with the patient and his family? What is the “worst case/best case” approach to such a discussion?
- Watch the video of the Grand Rounds discussion. What would you recommend to this patient and his family?
Annals of Internal Medicine is the premier internal medicine academic journal published by the American College of Physicians (ACP). It is one of the most widely cited and influential specialty medical journals in the world.