Suffering and Symptoms At the End of Life in ICU Patients Undergoing Renal Replacement Therapy.
Sarah J Ramer, Martin Viola, Paul K Maciejewski and 2 others
PMID 33827273WHAT IT FOUND
Nurses rated suffering as elevated in 71% of ICU patients undergoing renal replacement therapy for acute kidney injury, compared to 49% of those not receiving it.
Painful broken skin, rashes, and fecal incontinence were significantly more likely to contribute to suffering in this group.
Key findings
01Patients undergoing renal replacement therapy for acute kidney injury were significantly more likely to have elevated suffering ratings than those not receiving renal replacement therapy.
02Painful broken skin, rashes, and fecal incontinence were significantly more likely to contribute to suffering in patients undergoing renal replacement therapy for acute kidney injury compared to non-renal replacement therapy patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relies entirely on nurse ratings of suffering, which are subjective and may differ from patient experience. It is an observational design, so it cannot prove that renal replacement therapy caused the increased suffering; other unmeasured factors may be responsible. The sample was from a single quaternary hospital, which may limit generalizability to other settings. Researchers lacked detailed clinical data such as specific medication doses or renal replacement therapy adequacy, preventing adjustment for these variables.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not assume that renal replacement therapy itself is the direct cause of the increased suffering. The study is observational and cannot rule out that patients receiving this therapy were simply sicker or had different preferences for aggressive care that contributed to their distress.