End Stage Renal Disease
A New Trajectory of Functional Decline in the Last Year of Life

Mapping illness trajectories has been a valuable way to depict how the needs of healthcare changes over time and how interventions can best meet these changing needs. As the population ages, there are increasing numbers of patients who are developing End-Stage Renal Disease (ERSD). These patients are our aging population with a tendency of multiple comorbidities and a large number of these patients are choosing again the option of dialysis. The objective of this study was to determine the functional trajectory in the last year of life in end-stage renal disease in patients who were managed without dialysis. This was a longitudinal cohort study of functional status over time and toward death. The participants were patients with Stage 5 chronic kidney disease, from three different renal units in the United Kingdom between April 2005 and November 2006.

These patients were managed conservatively, and the main outcome measure was functional status measured with the Karnofsky Performance Scale. This scale is a well-established 10-point scale from 100 (full function) to 0 (death) that emphasizes physical performance and dependency. Seventy-five patients were followed monthly for up to two years. Forty-nine died during follow up and analysis according to time before death revealed that functional status remained stable during the last year of life but declined steeply in the last month of life.

The conclusion of this study showed that healthcare services need to be rapidly responsive to changing needs in this population as renal function declines in the last months of life. End of life services for conservatively managed ESRD needs to be rapidly responsive to changing the functional status and associated healthcare needs if they are to deliver a good death for the patient and their family.


Fliss E.M. Murtagh, P., Julia M. Addington-Hall, P., & Irene J. Higginson, P. (2011, March 17). A New Trajectory of Functional Decline in the Last Year of Life. Retrieved April 7, 2011, from Medscape News Nurses: http://www.medscape.com/viewarticle/737710

Fliss E.M. Murtagh, P., Julia M. Addington-Hall, P., & Irene J. Higginson, P. (2011). End Stage Renal Disease. Journal of the American Geriatrics Society, 304-308. (Audria Herrera)

Hysterectomy Rasies Risk for Renal Cell Carcinoma
Hysterectomy is not related to cancer in most cases and usually benign. Evidence suggests that the surgery may be linked to this most common type of kidney cancer, which occurs in the lining of the proximal convoluted tubule, making hysterectomy a preventable cause of the disease. Using data from 1973 to 2003, accumulated through a compilation of Swedish healthcare registries including the Classification of Operations and Major Procedures, Cancer, and Cause-of-Death registries, the investigators launched a population-based cohort study. The study involved 184,945 women who had undergone hysterectomy and 657,288 matched women with intact uteruses. The incidence rates per 100,000 were 17.4 in women who had a hysterectomy, and 13.1 whose uterus were not removed.

This gives women who are considering the benign operation information to think about. I believe this is reliable information due to the fact that evidence has backed it up. What can be thought as a simple benign procedure can truly potentially end up clinically significant in the long run.

The Swedish Society of Medicine. (2010). Hysterectomy Raises Risk for Renal Cell Carcinoma. Retrieved April 8, 2011, from Medscape: http://www.medscape.com/viewarticle/734357


Washington Deceit. (2007, May 9). Renal Cell Carcinoma - Hypernephroma. Retrieved April 9, 2011, from Youtube: http://www.youtube.com/watch?v=NBLxhZk_jTA
Article and Video by Greg Volz