Publications
300 results found
Iyasere O, Johansson L, Brown EA, 2014, Dialysis in the nursing home: Caring for patients with ESRD, Journal of Renal Nursing, Vol: 6, Pages: 120-125, ISSN: 2041-1448
<jats:p> As the population ages, the incidence of end-stage renal disease (ESRD) in older people is rising. Nursing home residents are predominantly older and account for up to 4.8% of the ESRD population. This group of patients are frail and comorbid with multiple symptoms and cognitive impairment. Survival is poor in the older patient with ESRD, with the 1-year mortality rate approaching 35%. Therefore, managing such patients can be particularly challenging. The debate continues as to how best approach the management of ESRD in this high-risk group. This article discusses the dialysis options for nursing home residents, highlighting the potential advantages and disadvantages of each. It advocates conservative care as a valid alternative in this population. It also discusses the need for a multidisciplinary approach to medical care and advance care planning for end of life. </jats:p>
Van der Veer SN, de Luijtgaarden MWV, Brown EA, et al., 2014, THE DECISION TO WITHDRAW DIALYSIS: EUROPEAN NEPHROLOGISTS' PERCEPTIONS OF ASSOCIATED FACTORS, 51st Congress of the European-Renal-Association(ERA)/European-Dialysis-and-Transplant-Association (EDTA), Publisher: OXFORD UNIV PRESS, Pages: 32-32, ISSN: 0931-0509
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- Citations: 1
Brown EA, Iyasere O, Johansson L, et al., 2014, FRAIL ELDERLY PATIENT OUTCOMES ON DIALYSIS (FEPOD): PART 1-ACROSS-SECTIONAL COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND HAEMODIALYSIS, 51st Congress of the European-Renal-Association(ERA)/European-Dialysis-and-Transplant-Association (EDTA), Publisher: OXFORD UNIV PRESS, Pages: 275-276, ISSN: 0931-0509
Brown E, Iiyasere O, Johansson L, et al., 2014, FRAIL ELDERLY PATIENT OUTCOMES ON DIALYSIS (FEPOD) PART 1: DESCRIPTIVE ANALYSIS OF SECONDARY OUTCOMES, 51st Congress of the European-Renal-Association(ERA)/European-Dialysis-and-Transplant-Association (EDTA), Publisher: OXFORD UNIV PRESS, Pages: 272-273, ISSN: 0931-0509
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- Citations: 1
Goodlad C, Tam FWK, Ahmad S, et al., 2014, DIALYSATE CYTOKINE LEVELS DO NOT PREDICT ENCAPSULATING PERITONEAL SCLEROSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 34, Pages: 594-604, ISSN: 0896-8608
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- Citations: 18
Banerjee G, Karia S, Varley J, et al., 2014, Cognitive Impairment in Elderly Renal Inpatients: An Under-Identified Phenomenon, NEPHRON CLINICAL PRACTICE, Vol: 126, Pages: 19-23, ISSN: 1660-2110
Muthalagappan S, Johansson L, Kong WM, et al., 2013, Dialysis or conservative care for frail older patients: ethics of shared decision-making, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 28, Pages: 2717-2722, ISSN: 0931-0509
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- Citations: 50
Balda S, Power A, Papalois V, et al., 2013, IMPACT OF HERNIAS ON PERITONEAL DIALYSIS TECHNIQUE SURVIVAL AND RESIDUAL RENAL FUNCTION, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 33, Pages: 629-634, ISSN: 0896-8608
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- Citations: 28
Banerjee G, Haase-Fielitz A, Brown EA, 2013, Quality of life, functional status, and specific medical problems in older patients, Managing Renal Injury in the Elderly Patient, Pages: 73-83, ISBN: 9783642399466
For older patients burdened by acute kidney injury (AKI)- or chronic kidney disease (CKD)-related comorbidities, quality of life is frequently reported to be of more importance than length of life. Aspects in the management of older patients with AKI are the establishment of strategies to prevent or slow functional decline, cognitive changes and the development of additional morbidities during AKI. Assessment of fluid balance and nutritional status in older patients with AKI and appropriate replacement and monitoring are also of importance, taking into account renal function and alteration in volume distribution. The presence of AKI in the setting of critical illness should never lead to restrictions in nutritional support. Systematic cognitive testing before initiation of extracorporeal renal replacement therapy and periodically thereafter may be warranted. In addition, multidisciplinary strategies could help to reduce long-term morbidity and mortality in older patients with AKI after hospital discharge.
Goodlad C, Brown E, 2013, The role of peritoneal dialysis in modern renal replacement therapy, POSTGRADUATE MEDICAL JOURNAL, Vol: 89, Pages: 584-590, ISSN: 0032-5473
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- Citations: 16
Johansson L, Hickson M, Brown EA, 2013, Influence of Psychosocial Factors on the Energy and Protein Intake of Older People on Dialysis, JOURNAL OF RENAL NUTRITION, Vol: 23, Pages: 348-355, ISSN: 1051-2276
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- Citations: 16
El-Sherbini N, Duncan N, Hickson M, et al., 2013, NUTRITION CHANGES IN CONSERVATIVELY TREATED PATIENTS WITH ENCAPSULATING PERITONEAL SCLEROSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 33, Pages: 538-543, ISSN: 0896-8608
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- Citations: 6
Sulemane S, Panoulas VF, Bratsas A, et al., 2013, SUBCLINICAL ABNORMALITIES OF LEFT VENTRICULAR MYOCARDIAL DEFORMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND NORMAL LEFT VENTRICULAR EJECTION FRACTION, 62nd Annual Scientific Session of the American-College-of-Cardiology, Publisher: ELSEVIER SCIENCE INC, Pages: E1077-E1077, ISSN: 0735-1097
Hobson J, Brown EA, 2013, Renal and urological disease, Fitness for Work, Publisher: Oxford University Press, Pages: 398-412
<p>The kidney has the vital function of excretion, and controls acid–base, fluid, and electrolyte balance. It also acts as an endocrine organ. Renal failure, with severe impairment of these functions, results from a number of different processes, most of which are acquired, although some may be inherited. Glomerulonephritis, which presents with proteinuria, haematuria, or both, may be accompanied by hypertension and impaired renal function. Pyelonephritis with renal scarring is the end result of infective disorders. Diabetes is now the commonest cause of end-stage renal disease (ESRD) in the UK and other systemic disease such as hypertension and collagen disorders can also affect the kidney. Polycystic kidney disease is the commonest inherited disorder leading to renal failure. Chronic renal failure implies permanent renal damage, which is likely to be progressive and will eventually require renal replacement therapy. Treatment of ESRD using haemodialysis (HD) and peritoneal dialysis (PD) can significantly improve physical and metabolic well-being and function but the proportion of those who continue to work with ESRD remains very low despite advances in treatment. Kidney transplantation enables many patients to return to normal lives including work. Reintegration of patients into the workforce following transplantation or dialysis offers an exciting and rewarding challenge to the wider health team. Renal disease is not within the top ten of the most costly diseases for employers and accounts for less than 1 per cent of sickness absence and incapacity claims. Urinary incontinence affects significant proportions of the workforce particularly women. Better management of urinary infections and calculi, prostatic obstruction, incontinence, and other complications of urinary tract disease has significantly reduced time lost from work.</p>
Power A, Brown E, 2013, Optimising Treatment of End-Stage Renal Disease in the Elderly, NEPHRON CLINICAL PRACTICE, Vol: 124, Pages: 202-208, ISSN: 1660-2110
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- Citations: 11
Figueiredo AE, Goodlad C, Clemenger M, et al., 2012, Evaluation of physical symptoms in patients on peritoneal dialysis, International Journal of Nephrology, Vol: 2012, ISSN: 2090-214X
Introduction. Little is known about physical symptoms in peritoneal dialysis (PD) Patients. This study aims to determine the prevalence of symptoms (general and abdominal) in PD patients. Methods. A cross-sectional study, with subsequent followup, using an author-designed 21 symptoms questionnaire (15 nonabdominal and 6 abdominal). Each symptom was assessed on a scale 03 for severity (nonesevere) and frequency (neverevery day). Results. We studied 41 patients, mean age 60±15 years, 56 male, 19.5 diabetics, and 51.5 on APD. Mean number of symptoms was 9.5±3.9 and total symptoms score was 28.5±12 with abdominal scores of 6.4±4.8. Most frequent symptoms were lack of energy, itching, cramps, poor sleep, and loss of appetite. A second evaluation in 20 patients disclosed no statistical difference between the first and second assessments, or between subgroups. Cramps were the only symptoms which decreased over time (P=0.120). Lack of energy did not correlate with haemoglobin, neither did itching with phosphate level. Conclusions. Physical symptoms are frequent and troublesome; they relate to advanced kidney disease and not specifically to PD. Symptoms remain stable over time and do not appear to relate to dialysis parameter markers. © 2012 Ana Elizabeth Figueiredo et al.
, 2012, An optimal dialysis modality for the elderly, Journal of Renal Nursing, Vol: 4, Pages: 271-271, ISSN: 2041-1448
Brown EA, 2012, What can we do to improve quality of life for the elderly chronic kidney disease patient?, Aging Health, Vol: 8, Pages: 519-524, ISSN: 1745-509X
Chronic kidney disease, including end stage, is more common with increasing age. It most commonly occurs alongside other diseases. There are therefore increasing numbers of older people living with chronic kidney disease alongside their other chronic conditions and the general problems associated with aging. Therefore, the quality of life needs to be a key outcome when considering management and interventions. Guidelines for referral to renal clinics should be followed in order to avoid unnecessary outpatient visits and investigations. Discussions with patients and families about dialysis should include impact on lifestyle and honesty about likely prognosis. For frail patients, there may be no difference in survival rates between those receiving conservative care and those on dialysis. Development of assisted peritoneal dialysis provides the option of home treatment rather than default hospital hemodialysis. Measures of quality and standard of treatment for older people with chronic kidney disease should move away from purely medical targets and include measures of patient outcomes. © 2012 Future Medicine Ltd.
Brown EA, 2012, Quality of life at end of life., J Ren Care, Vol: 38 Suppl 1, Pages: 138-144
Patients with chronic kidney disease, particularly those with diabetes, often have a heavy burden of vascular comorbidity and hence a poor overall prognosis. Unfortunately, patients and their healthcare teams often have unrealistic expectations about outcomes and receive ineffective and often harmful interventions towards their end of life. We need to move away from death being perceived as a failure and realise, instead, that our goal of care at the end of life is to achieve as good a quality of life for the patient as possible. To be able to achieve this, it is important to be realistic about prognosis, be able to recognise predictors of poor outcome and then be able to discuss these with the patient and their family to ensure symptom control, avoid interventions that could do harm and then as the end approaches, determine the wishes of the patient regarding preferred place of care for their inevitable death.
Brown EA, 2012, Non-Dialysis Therapy: A Better Policy Than Dialysis Followed by Withdrawal?, SEMINARS IN DIALYSIS, Vol: 25, Pages: 26-27, ISSN: 0894-0959
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- Citations: 3
O'Kelly CDP, Urch C, Brown EA, 2011, The impact of culture and religion on truth telling at the end of life, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 26, Pages: 3838-3842, ISSN: 0931-0509
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- Citations: 55
Chambers EJ, Brown E, Germain M, 2011, Supportive Care for the Renal Patient, ISBN: 9780199560035
This book provides an evidence-based overview of supportive care for the nephrology patient. An international group of contributors emphasize the continuum of palliative care from the time of diagnosis through to end-of-life care and the issues surrounding withdrawal of dialysis. The book addresses the psychological impact of the disease, the importance of involving the patient in making decisions about their care, ethical considerations, the role of the family and the multidisciplinary team. This second edition includes two new chapters on conservative management of advanced kidney disease (AKD) and dialysis in the very elderly. The chapters covering non pain symptoms, advance care planning, quality of life, psychological and psychiatric consideration, and end-of-life care have also be completely revised to include new evidence and current thinking.
Chambers EJ, Brown EA, 2011, The concept of supportive care for the renal patient, Supportive Care for the Renal Patient, ISBN: 9780199560035
This chapter discusses supportive care, which centres on the patients of ESRD and focuses on the wishes and goals of the individual. Thanks to the team-based approach of ESRD patient care, programmes for the management of ESRD should have supportive care, along with routine prevention, diagnosis, transplantation, and RRT. This chapter includes sections on supportive care in nephrology practice, the need for supportive care, and palliative and end-of-life care.
Johansoon L, Brown EA, 2011, End-stage renal disease in the older person, Supportive Care for the Renal Patient, ISBN: 9780199560035
This chapter discusses old people who have ESRD. It defines the term 'old' as a person who has lived a long time and is no longer young. The chapter states that before the 1970s, dialysis treatment was only available to patients who were no older than fifty, but due to the increase in the number of older people who needed dialysis, this treatment was soon made available to those people as well. It discusses a number of factors, such as nutrition, frailty, depression, and cognitive function.
Chambers EJ, Brown EA, Germain M, 2011, Preface, Supportive Care for the Renal Patient, ISBN: 9780199560035
McAdoo S, Brown E, Chesser A, et al., 2011, Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group., Nephrol Dial Transplant
Brown EA, Johansson L, 2011, Epidemiology and management of end-stage renal disease in the elderly, NATURE REVIEWS NEPHROLOGY, Vol: 7, Pages: 591-598, ISSN: 1759-5061
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- Citations: 40
Piraino B, Bernardini J, Brown E, et al., 2011, ISPD POSITION STATEMENT ON REDUCING THE RISKS OF PERITONEAL DIALYSIS-RELATED INFECTIONS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 31, Pages: 614-630, ISSN: 0896-8608
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- Citations: 232
Goodlad C, Tarzi R, Gedroyc W, et al., 2011, Screening for encapsulating peritoneal sclerosis in patients on peritoneal dialysis: role of CT scanning, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 26, Pages: 1374-1379, ISSN: 0931-0509
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- Citations: 29
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