From the Guidelines
Nausea in patients with End-Stage Renal Disease (ESRD) should be managed on a case-by-case basis, as there is limited systematic evidence to guide treatment.
Treatment Considerations
- The management of nausea in ESRD patients has not been studied systematically, and therefore, treatment approaches are not well established 1.
- However, in clinical practice, non-pharmacologic measures such as dietary changes, relaxation techniques, and acupuncture may be considered as initial management strategies.
- Pharmacologic interventions may also be used, but the choice of medication should be guided by the patient's overall clinical condition, potential drug interactions, and the risk of adverse effects.
- It is essential to monitor patients closely for efficacy and safety when using any medication to manage nausea in ESRD patients.
General Principles
- The treatment of nausea in ESRD patients should be individualized, taking into account the patient's underlying medical condition, comorbidities, and other symptoms.
- A multidisciplinary approach involving nephrologists, palliative care specialists, and other healthcare professionals may be necessary to provide comprehensive care for ESRD patients with nausea.
- Basic principles of symptom management, such as assessing the patient's symptoms, identifying potential causes, and using a stepped-care approach, should be applied when managing nausea in ESRD patients.
From the Research
Treatment for Nausea in ESRD Patients
- Nausea is a common symptom in patients with End-Stage Renal Disease (ESRD), affecting their quality of life 2, 3, 4.
- Several medications can be used to manage nausea in ESRD patients, including:
- Mirtazapine, a noradrenergic antagonist and selective serotonin antagonist, has been proposed as a potential one-stop pharmacologic agent to alleviate multiple symptoms, including nausea, in ESRD patients 3.
- Intradialytic complications, such as nausea and vomiting, can occur during hemodialysis sessions, with a frequency of 11.7% in one study 4.
Management of ESRD Symptoms
- Controlling blood pressure, managing anemia, and optimizing dialysis can help alleviate symptoms, including nausea, in ESRD patients 5, 2.
- A palliative approach to ESRD is a reasonable alternative to dialysis, particularly for individuals with limited life expectancy, severe comorbid conditions, or those who wish to avoid medical interventions 5, 6.
- Patients with ESRD should have advance directives, including documentation of situations in which they would no longer want dialysis 2.