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Palliative Care and Nephrology: Moving Upstream Together

  • 1 Daniel Lam, MD, is Clinical Assistant Professor of Medicine, University of Washington Department of Medicine, Division of Nephrology, and Palliative Care Medical Advisor at Northwest Kidney Centers, Harborview Medical Center, in Seattle, WA
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Patients with ESRD experience a high degree of symptom burden—physical symptom burden akin to patients with advanced cancer, along with emotional and spiritual suffering. In addition, ESRD patients on maintenance dialysis have the highest levels of medicalization at the end of life, surpassing what is experienced by their counterparts with other advanced chronic illnesses (1). Although high-intensity health care at the end of life may be goal concordant for a minority of patients, it is not on a population level. A large Veterans Affairs study evaluated family-reported quality of end-of-life care among 57,753 decedents and noted that quality

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