Symptom control in patients with renal disease and cardiac failure
Symptom control measures may need to be modified in cancer patients who have concurrent illness or who have organ failure as part of their malignant disease. Patients who have non-malignant, end-stage organ failure often have palliative care and symptom control needs.
The principles of pain and symptom control previously described for cancer patients can be modified for use in patients with non- cancer disease who are being managed palliatively. The concept of total pain and identification of the cause and nature of pain remains important. The prescription of analgesia by the clock, by the WHO ladder and by mouth, where possible, is ideal. However the choice and dose of analgesia and other symptom control drugs may need to be modified depending upon the underlying disease(s).
The following guidelines aim to provide general symptomatic prescribing advice for patients who are being managed palliatively with a diagnosis of:
• renal disease or
• cardiac failure or
• renal disease and/or cardiac failure in addition to a malignant condition
Identification of the palliative phase in non-malignant conditions can be more difficult and unpredictable than in cancer patients.
Advice should be sought from the patient’s specialist team and the Specialist Palliative Care Team if necessary, alongside discussion with the patient and family.
Management of patients on dialysis should always be discussed with their Renal Team.