Abstract, Background & Contributors
Abstract Background Authors & Contributors Abstract In South Africa, there is a high burden of end-stage kidney disease (ESKD). This is due to the burgeoning epidemics of communicable diseases like HIV/AIDS and non-communicable diseases, particularly hypertension and diabetes mellitus. One of the most difficult situations encountered by healthcare professionals dealing with patients with ESKD
Abstract
In South Africa, there is a high burden of end-stage kidney disease (ESKD). This is due to the burgeoning epidemics of communicable diseases like HIV/AIDS and non-communicable diseases, particularly hypertension and diabetes mellitus. One of the most difficult situations encountered by healthcare professionals dealing with patients with ESKD in South Africa is the management of a conservative or palliative care pathway for the many patients who have no other option. Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes and high costs of care. Many patients are managed in primary healthcare settings and either do not have access to palliative care or are not referred appropriately.
Renal supportive and palliative care involves a multidisciplinary approach to managing patients with ESKD, to ensure that symptoms are managed optimally and to provide support during advanced disease. It aims to improve quality of life for patients and their families and must be provided alongside curative medical care. This support should include those unable to gain access to life-saving dialysis and it should also provide care for patients where dialysis is not the best option.
The aim of this consensus statement is to assist healthcare providers to improve the management of symptoms and biopsychosocial factors of patients with ESKD in a South African context. The document was compiled through consensus building among healthcare professionals across South Africa. The professionals represented included nephrologists, palliative care physicians, social workers, nurses, paediatricians and hospital managers. We wish to acknowledge the contribution of Dr Frank Brennan, a leading expert in renal palliative and supportive care, who assisted greatly in the compilation of this document.
Background
The incidence of end-stage kidney disease (ESKD) is increasing worldwide. In South Africa, the high degree of ESKD is due to burgeoning epidemics of communicable (such as HIV/AIDS) and non-communicable diseases, particularly hypertension and diabetes mellitus. However, the access to life-saving dialysis and transplantation is severely limited in the public health sector. Palliative and renal supportive care (RSC) aims to relieve the suffering of patients and families. Although we are unable to dialyse all patients, we can advocate that all patients receive equitable and comprehensive renal supportive and palliative care (RSC/ PC). This care must be provided alongside treatment that may be curative and must not only be initiated at the very end of a patient’s life [1]. In some cases, it may need to occur at the time of diagnosis, for example in the case of children with multi-organ involvement.
The aim of this document is to improve the care of all patients with ESKD whether receiving renal replacement therapy (RRT) or not, by integrating nephrology care, palliative care and family practice. It aims to align with the fundamental principles of Universal Health Coverage (UHC) [2] and has the secondary goal of creating awareness regarding an alternative conservative management pathway, where appropriate. It has been written by a multiprofessional team in the hope that it will encourage multidisciplinary care and is intended for use by healthcare professionals in primary care, internal medicine and nephrology in South Africa.
This document was compiled through consensus building among healthcare professionals across South Africa. On 11 June 2019, 60 participants conducted a workshop in Cape Town to define and make recommendations on the main concerns and needs of ESKD patients. The professionals represented included nephrologists, palliative care physicians, social workers, nurses, paediatricians and hospital managers from across the country. The workshop also hosted Dr Frank Brennan, a leading expert in renal palliative and supportive care. He is renowned internationally, for his work on human rights in health care.
Authors & Contributors
Compiled by:
Prof Nicola Wearne1
Dr Rene Krause2
Dr Bianca Davidson1
Dr Frank Brennan3
Scribe:
Prof Liz Gwyther2
Contributors:
| Dr M Abbas4 | Dr Z Barday1 |
| Dr A Barnard2 | Dr K Bezuidenhout5 |
| Prof M Blockman6 | Dr L Bloemhof4 |
| Mr B Bidii4 | Dr MY Chothia7 |
| Dr C Cox4 | Prof MR Davids7 |
| Dr S De Bruin4 | Dr E de Vries8 |
| Dr B Eick9 | Dr J Ensor10 |
| Dr K Evans11 | Dr N Fouche12 |
| Dr C February12 | Dr P Gajjar13 |
| Dr R Freercks10 | Ms R Govender4 |
| Dr T Govender4 | Dr L Hellstrom4 |
| Dr L Holding4 | Dr I Katz14 |
| Dr S Kibel4 | Dr J Kumari15 |
| Prof U Kyricos12 | Ms. A Mentor16 |
| Dr L Lotter17 | Dr C Marx4 |
| Prof M McCulloch18 | Dr J Morgan4 |
| Dr N Matsiliza4 | Dr M Meiring13 |
| Miss P Mkhize19 | Dr O Modupe20 |
| Dr G Moonsamy21 | Dr T Motsohi8 |
| Prof MR Moosa22 | Mr J Mwangi12 |
| Prof S Naicker23 | Dr T Nupen13 |
| Dr Shannon Odell4 | Prof G Paget24 |
| Miss F Phelanyane8 | Dr M Pretorius4 |
| Dr J Rajbaran17 | Dr L Spies4 |
| Dr P Stead25 | Mrs Aletta Stubbs26 |
| Prof I van Biljon27 | Dr V Rekhviashvili24 |
| Dr M van Jaarsveld4 | Dr M Venter4 |
| Dr S Venter28 | Dr A Vermeulen29 |
| Dr L Walker4 | Mrs K White10 |
| Dr J Wiles13 |
Institutions:
1Division of Nephrology and Hypertension, Groote Schuur Hospital, Nephrology and Hypertension Research Unit, University of Cape Town;
2Palliative Medicine, Division of Family Medicine, University of Cape Town and Groote Schuur Hospital;
3Calvary Healthcare and St George Hospital, Sydney, Australia;
4Association of Palliative Care Practitioners of South Africa (PalPrac);
5Division of Nephrology, Department of Medicine, Robert Mangaliso Sobukwe Hospital, Kimberley;
6Division of Clinical Pharmacology, Groote Schuur Hospital, University of Cape Town;
7Division of Nephrology, Tygerberg Hospital and Stellenbosch University, Cape Town;
8School of Public Health and Family Medicine, University of Cape Town;
9Medical Management, Groote Schuur Hospital, Cape Town;
10Renal Unit, Livingstone Tertiary Hospital and Division of Nephrology and Hypertension, Nephrology and Hypertension Research Unit, University of Cape Town;
11Emergency Medicine, Mitchells Plain Hospital;
12Department of Nursing, University of Cape Town;
13PaedsPal Paediatric Palliative Care;
14Department of Renal Medicine, St George Hospital, University of New South Wales, Sydney, Australia;
15Department of Health, Western Cape Government;
16Department of Social Work, Groote Schuur Hospital, Cape Town;
17Paarl Hospital;
18Department of Nephrology, Red Cross Children’s Hospital, Cape Town;
19Life Healthcare;
20Council for Medical Schemes, South Africa;
21Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg;
22Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town;
23Department of Internal Medicine, University of the Witwatersrand, Johannesburg;
24Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg;
25Vincent Pallotti Hospital, Cape Town;
26Division of Nursing and Midwifery, University of Cape Town;
27Division of Paediatric Nephrology, Steve Biko Academic Hospital, Pretoria;
28Sungardens Hospice, Pretoria;
29George Provincial Hospital.
Wearne, N., Krause, R., Davidson, B., and Brennan, F., 2020. Renal palliative and supportive care in South Africa – A consensus statement. African Journal of Nephrology, 23(1), pp.86-107.