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Review
. 2023 Dec 19:10:1225823.
doi: 10.3389/fcvm.2023.1225823. eCollection 2023.

Consensus document on palliative care in cardiorenal patients

Clara Bonanad  1   2   3 , Juan M Buades  4   5 , Juan Pablo Leiva  6 , Rafael De la Espriella  1   2   3 , Marta Cobo Marcos  3   7 , Julio Núñez  1   2   3 , Helena García-Llana  8   9 , Lorenzo Facila  10 , Rosa Sánchez  11 , Laura Rodríguez-Osorio  11 , Alberto Alonso-Babarro  12 , Borja Quiroga  10 , Daznia Bompart Berroteran  2 , Carmen Rodríguez  13 , Daniela Maidana  2 , Javier Díez  3   14
Affiliations
Review

Consensus document on palliative care in cardiorenal patients

Clara Bonanad et al. Front Cardiovasc Med. .

Abstract

There is an unmet need to create consensus documents on the management of cardiorenal patients since, due to the aging of the population and the rise of both pathologies, these patients are becoming more prevalent in daily clinical practice. Chronic kidney disease coexists in up to 40%-50% of patients with chronic heart failure cases. There have yet to be consensus documents on how to approach palliative care in cardiorenal patients. There are guidelines for patients with heart failure and chronic kidney disease separately, but they do not specifically address patients with concomitant heart failure and kidney disease. For this reason, our document includes experts from different specialties, who will not only address the justification of palliative care in cardiorenal patients but also how to identify this patient profile, the shared planning of their care, as well as knowledge of their trajectory and the palliative patient management both in the drugs that will help us control symptoms and in advanced measures. Dialysis and its different types will also be addressed, as palliative measures and when the decision to continue or not perform them could be considered. Finally, the psychosocial approach and adapted pharmacotherapy will be discussed.

Keywords: cardiorenal patients; cardiovascular medicine; chronic heart failure; chronic kidney disease; palliative care.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The Pentagon needs to be considered for integrating palliative care into the care of cardiorenal patients.
Figure 2
Figure 2
Symptoms and signs of heart failure.
Figure 3
Figure 3
Interdisciplinary palliative care intervention in advanced heart failure.
Figure 4
Figure 4
End-of-life care.
Figure 5
Figure 5
Conceptual framework of palliative care in cardiorenal syndrome.
Figure 6
Figure 6
Roadmap for the development of supportive and palliative care programs in cardiorenal syndrome.
Figure 7
Figure 7
Survival in patients with Heart Failure compared to Cardiorenal Syndrome.
Figure 8
Figure 8
Prognostic predictors in cardiorenal syndrome.
Figure 9
Figure 9
Functional end-of-life trajectory.
Figure 10
Figure 10
Drug recommendations in the different stages of chronic kidney disease.
Figure 11
Figure 11
Prevalence of the most frequent symptoms and degree of severity in patients with advanced cardiorenal disease.
Figure 12
Figure 12
Edmonton Symptom Assessment System (ESAS-r).
Figure 13
Figure 13
Integrated palliative care outcome scale (IPOS-renal).
Figure 14
Figure 14
Etiopatogenic factor of asthenia.
Figure 15
Figure 15
Richmond Agitation Sedation Scale (RASS).
See this image and copyright information in PMC

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