Palliative care for patients with advanced chronic kidney disease

Over the past three decades there has been a dramatic rise in the number of patients with advanced chronic kidney disease. The fastest expanding group receiving dialysis has been the elderly. However, for those patients who are very elderly with co-morbidity, dialysis may not offer a survival advantage. Therefore, active conservative management is a growing service offered by many renal units in the UK and focuses on non-dialytic correction of fluid and electrolyes, management of renal anaemia, and assessment and management of symptoms.

Pain in medical inpatients: an under-recognised problem?

Pain is a common feature of a range of illnesses. Although it is perceived as a significant problem for surgical patients and those with terminal malignancy, there is a paucity of evidence regarding the prevalence of pain in general medical patients. This study set out to determine pain prevalence and the contribution of chronic pain in a teaching hospital medical unit. All wards on the medical unit were visited on three consecutive days and all eligible patients were asked to complete a questionnaire indicating occurrence and severity of pain.