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End-stage kidney disease 

End-stage kidney disease
End-stage kidney disease

Fliss E. M. Murtagh

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date: 16 May 2022

End-stage kidney disease (ESKD) accounts for 1-2% of all deaths. Ageing populations means that this proportion will grow steadily over the coming years. Symptom burden in ESKD exceeds advanced cancer, with added renal-specific symptoms, such as itch and restless legs. Pain and depression are also more prevalent. Many renal symptoms go under-recognized and under-treated, especially as they arise from co-morbid conditions, rather than the renal disease itself. The most useful intervention to address symptoms is regular assessment of symptoms, using a valid and reliable global symptom score. Pharmacological interventions to alleviate symptoms need to take account of the severe constraints on using renally cleared drugs, and the high risk of toxicity from accumulation of parent compound or metabolites. The population with ESKD has extensive palliative care needs, and need significant medical, nursing, psychological, and social care to address these as their illness advances towards the end of life.

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