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World J Nephrol. Dec 17, 2018; 7(8): 148-154
Published online Dec 17, 2018. doi: 10.5527/wjn.v7.i8.148
Palliative care for acute kidney injury patients in the intensive care unit
Vinod Krishnappa, William Hein, Daniel DelloStritto, Mona Gupta, Rupesh Raina
Vinod Krishnappa, William Hein, Daniel DelloStritto, Northeast Ohio Medical University, Rootstown, OH 44272, United States
Vinod Krishnappa, Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH 44302, United States
Mona Gupta, Department of Hospice and Palliative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
Rupesh Raina, Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates and Akron Children's Hospital, Akron, OH 44307, United States
Author contributions: All the authors equally participated in data collection, initial draft of the manuscript, developing figures, and revision and approval of final version of the manuscript.
Conflict-of-interest statement: The authors have declared that no conflict of interest exists.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Rupesh Raina, MD, Associate Professor, Department of Nephrology, Cleveland Clinic Akron General, 224 W. Exchange Street, Akron, OH 44307, United States. rraina@akronchildrens.org
Telephone: +1-330-5438950 Fax: +1-330-5433980
Received: September 3, 2018
Peer-review started: September 3, 2018
First decision: October 8, 2018
Revised: October 25, 2018
Accepted: December 5, 2018
Article in press: December 5, 2018
Published online: December 17, 2018
Processing time: 106 Days and 1.6 Hours
Abstract

Patients with acute kidney injury (AKI) in the intensive care unit (ICU) are often suitable for palliative care due to the high symptom burden. The role of palliative medicine in this patient population is not well defined and there is a lack of established guidelines to address this issue. Because of this, patients in the ICU with AKI deprived of the most comprehensive or appropriate care. The reasons for this are multifactorial including lack of palliative care training among nephrologists. However, palliative care in these patients can help alleviate symptoms, improve quality of life, and decrease suffering. Palliative care physicians can determine the appropriateness and model of palliative care. In addition to shared decision-making, advance directives should be established with patients early on, with specific instructions regarding dialysis, and those advance directives should be respected.

Keywords: Palliative care; Acute kidney injury; Intensive care unit; Dialysis; Advance directives

Core tip: Role of palliative medicine in nephrology is not well defined and the patients with acute kidney injury in the intensive care unit may not receive the most comprehensive care surrounding their illness due to scarcity of established palliative care guidelines and lack of palliative care training among nephrologists. A multidisciplinary approach involving palliative care physician early in the course of illness may help in comfort care of acute kidney injury patients in the intensive care unit. Shared decision-making and advance directives play an important role guiding the physician as to what patient wishes are, and those decisions should be respected.