Palliative Care for Kidney Failure: Sam Gelfand, Kate Sciacca, and Josh Lakin

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GeriPal - A Geriatrics and Palliative Medicine Podcast 45 min 2 speakers 4 chapters transcribed 9 hours ago

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What is KidneyPal and why was it created?

Eric Widera 0:00

This episode of the Jerry Pal podcast is CME eligible.

Alex Smith 0:04

To claim credit, please go to the CME tab on jerrypal.org.

Eric Widera 0:09

Welcome to the Jerry Pal podcast. This is Eric Widera. This is

Alex Smith 0:12

Alex

Eric Widera 0:13

Smith. And Alex, who do we have with us today? We are

Alex Smith 0:15

delighted to welcome Josh Lakin, who's a palliative care doctor at Dana-Farber Cancer Institute and Brigham Women's Hospital, former fellow from here at UCSF. And I saw that he actually wrote a post on Jerry Pal back in 2013 when he was a fellow, but this is the first time on the podcast. Josh, welcome to the podcast. What was the post on? Something about DNR or code status?

Josh Lakin 0:40

Yeah, something like that.

Alex Smith 0:42

We're delighted also to welcome Sam Gelfand, who is a dual certified nephrologist and palliative care doctor, also at the Dana-Farber Cancer Institute and Brigham and Women's Hospital. Sam, welcome to the Jerry Powell Podcast.

Sam Gelfand 0:55

Thank you so much for having

Alex Smith 0:56

us. And Kate Shaka, who's a palliative care nurse practitioner at Dana-Farber Cancer Institute and Brigham and Women's Hospital. Kate, welcome to Jerry Powell.

Kate Sciacca 1:05

Thank you.

Eric Widera 1:05

Thank you. So we got a lot to talk about today about palliative neurology or kidney pal. But before we do, we always ask for a song request. Sam, do you have the song request?

Sam Gelfand 1:18

Yes. On behalf of the group, we would love to hear Down Under by Men at Work.

Eric Widera 1:24

Can I ask, why did you choose this song?

Sam Gelfand 1:27

Well, a lot of what we do in kidney palliative care derives from, I'd say, the worldwide pioneers in this kind of medicine at St. George Hospital in Sydney, where Kate and I both got to rotate when we were still fellows.

Eric Widera 1:42

Oh, nice. Shout

Alex Smith 1:47

out to our Australian colleagues.

1:54

Alex?

Alex Smith 1:56

on a hippie trail head full of zombies i met a strange lady she made me nervous she took me and she gave me breakfast do you come from the land of down under where women glow and men plunder can't you hear can't you hear the thunder You better run, you better take cover

Eric Widera 2:32

Sam, what's that song actually about?

Sam Gelfand 2:36

I think we should get our Australian colleagues on the line to explain it. There's a lot of vocabulary in there.

Alex Smith 2:43

There's a lot, yeah. The next verse, the next chorus features the word chunder, which I googled yesterday

Sam Gelfand 2:51

and

Alex Smith 2:51

learned

Josh Lakin 2:52

means

Alex Smith 2:52

to vomit. Where beer does flow and men chunder.

Josh Lakin 2:59

Especially if you drink your beer thickened, gentlemen.

Eric Widera 3:02

And a head full of zombies is a reference to... Yeah, a

Alex Smith 3:09

little bit of marijuana,

Eric Widera 3:10

I think, there, Eric. Yeah, bring it back to the 80s. That's 80s.

Alex Smith 3:21

At least 80s, if not earlier. You think

Eric Widera 3:24

it's

Alex Smith 3:24

earlier

Eric Widera 3:24

than the 80s? It

Alex Smith 3:25

might be.

Eric Widera 3:26

Well, that is not the topic of today's podcast. We're talking about Kidney Pal. So I think this started because we heard of a pretty interesting service at DataFarber. Is it called the KidneyPal service? Is that the technical word? That is. Tell us, when did this service start and what does it do? You

Josh Lakin 3:48

want me

Eric Widera 3:48

Josh Lakin 3:48

kick that one

Eric Widera 3:49

off?

Josh Lakin 3:50

Go ahead, Josh. All right. It's a service we started in about 2018, planning pre-COVID times, BC. The organization kind of realized that we had put so much of our energy into providing palliative care for people with cancer diagnoses. And we were leaving, I think, like many places, we're leaving some of the other groups underserved, notably. And so there's an institutional strategic planning process to figure out how to do something differently. How do we get palliative care to other populations? And as a subspecialized institution, Brigham identified a few areas where we could really lean into to do a better job getting palliative care to people. And one of those places was nephrology. The nephrologists and all the staff that worked there were hungry to have a palliative care team come and join them.

Josh Lakin 4:42

So we did some work building an embedded service for patients with kidney disease kind of within the nephrology division at the Brigham and staffed it. We were very lucky to get a full interprofessional, not quite full, but an interprofessional palliative care team dedicated to providing specialty palliative care for people with kidney disease. And we built it out from there. All types of kidney

Eric Widera 5:04

disease?

Josh Lakin 5:05

All types of kidney disease.

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Chapters

4 chapters

1 What is KidneyPal and why was it created? 0:00–19:54 2 When did the KidneyPal service launch and what does it do? 19:54–26:59 3 Who are the core members of the KidneyPal interdisciplinary team? 26:59–28:12 4 How does KidneyPal integrate inpatient and outpatient care? 28:12–45:47

Speakers

2 identified

Eric Widera 9 min Alex Smith 5 min

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Topics in this episode

Sydney 1 Brussels 1 Alex Smith 1 UCSF 1 Eric Widera 1 Brigham and Women's Hospital 1 Dana‑Farber Cancer Institute 1 CKM 2 Josh Lakin 1 Sam Gelfand 4 Kate Sciacca 2

Source

Recorded30 May 2024

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524553

Show notes

The landscape of options for treating people with kidney failure is shifting. It used to be that the "only" robust option in the US was dialysis. You can listen to our prior podcast with Keren Ladin talking about patients who viewed dialysis as their only option, and structural issues that led to this point (including this takedown of for profit dialysis companies by John Oliver). One of the problems was a lack of an alternative robust option to offer patients. As one of our guests says, you have to offer them something viable as an alternative to dialysis. Today we interviewed Sam Gelfand, dually trained in nephrology and palliative care, Kate Sciacca, a nurse practitioner (fellowship trained in palliative care), and Josh Lakin, palliative care doc, who together with a social worker and other team members started KidneyPal at DFCI/BWH, a palliative care consult service for people with advanced kidney disease. As a team, they provide a robust alternative to dialysis for patients with kidney failure: conservative kidney management. And "conservative," as they note, can mean not only a "conservative approach," as in non-invasive/less aggressive, but also an effort to "conserve" what kidney function remains. We get right down to the nitty gritty of kidney supportive care techniques they incorporate in clinic, including: Communication about the choice between dialysis and conservative kidney management: what are the tradeoffs? Function often declines after initiating dialysis, at least among nursing home residents. Dialysis may extend life, but those "additional" days are often spent in the hospital or dialysis, away from home. Symptoms are common in both options, though more anxiety and cramping in dialysis, more pruritus and nausea in conservative kidney management.. Introducing the idea of hospice early, at the time of diagnosis with kidney failure. Listen also to our prior podcast with Melissa Wachterman on hospice and dialysis. Approaches to treating fatigue Approaches to treating pain - the second most common symptom (!) - and the answer isn't tramadol (or tramadon't) - rather think buprenorphine patch or methadone, and how to dose gabapentin and pregabalin. Also, don't count out the NSAIDS! Approaches to treating itching/pruritus Approaches to treating nausea Our guests were deeply grateful to their colleagues Dr. Frank Brennan, Dr. Mark Brown, and clinical nurse consultant Elizabeth Josland of the renal supportive care team at St. George Hospital in Sydney, Australia (down under) for teaching them the ropes of palliative care in kidney failure. And we got to learn some new vocabulary, including the meaning of "chunder." Enjoy! -@AlexSmithMD

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