Remarkable Improvement in Kidney Function in a 93-Year-Old ESKD Patient Under Home Hospice Care

TL;DR

An elderly patient with severe kidney disease improved significantly under home hospice care in Israel, showing better kidney function and quality of life.

Contribution

This case highlights the potential of palliative care to improve kidney function in elderly ESKD patients in the Middle East, a phenomenon underreported in this region.

Findings

The patient's creatinine levels dropped from 7.6 to 3.2 mg/dL over six months.

GFR increased from 6.7 to 18.2 mL/min/1.73 m² with no further ER visits.

The patient showed improved cognition and effective management of peripheral edema.

Abstract

This report details the remarkable improvement in kidney function and quality of life in an ESKD 93-year-old male patient under conservative management in Israel. The patient, with previous postrenal obstruction due to prostate enlargement and recurring infections, exhibited significant kidney deterioration, reaching a creatinine level of 7.6 mg/dL and a GFR of 6.7 mL/min/1.73 m2 in December 2023. Following numerous hospitalizations and ER visits over the previous year, the patient opted for palliative care, prioritizing life quality over life-extending interventions. Over a 6 month period (December 2023–May 2024), the patient received comprehensive palliative care: nurse visits, bimonthly doctor consultations, and medication adjustments based on biochemical home blood tests. Despite initial severe kidney impairment, the patient's creatinine levels improved to 3.2 mg/dL and GFR increased to 18.2 mL/min/1.73 m2. Potassium and phosphorus stabilized, and no further ER visits were recorded. Clinically, the patient showed enhanced cognition, memory, and communication and managed peripheral edema effectively. This case underscores the potential benefits of conservative palliative management in an Israeli elderly patient, a phenomenon that is recognized in the US and Canada more often, but not highlighted in the Middle Eastern elderly population. Coordinated efforts of a skilled palliative care team and supportive home hospice care contributed to the patient's clinical improvement. These findings challenge the notion that is often communicated to Israeli ESKD patients, Hatoum and Sperling, that palliative treatment leads to further kidney function deterioration, suggesting that, in some cases, it can result in improved outcomes in an underreported population.

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