Germain Michael J, Cohen Lewis M
Departments of Medicine and Psychiatry, Baystate Medical Center, Springfield, MA 01107, USA.
Adv Chronic Kidney Dis. 2008 Apr;15(2):133-9. doi: 10.1053/j.ackd.2008.01.005.
The rapidly advancing age of incident dialysis patient has coincided with a rising mortality rate during the first year of dialysis. This is occurring despite a steady decline in mortality of prevalent patients. These statistics suggest that there is a subset of sick, elderly dialysis patients who will not survive the first 6 months of dialysis. It may be that these patients would be better served with a conservative, palliative approach that does not include initiation of dialysis. Even though hospice care is universally available to the Center for Medicare and Medicaid Services population, dialysis patients encounter many barriers to obtaining this benefit and have a hospice utilization rate only one quarter that of cancer patients. This article discusses the barriers to and goals of palliative care in the chronic kidney disease/end-stage renal disease population.
新进入透析治疗的患者年龄迅速增长，与此同时，透析第一年的死亡率也在上升。尽管长期透析患者的死亡率在稳步下降，但这种情况仍在发生。这些统计数据表明，有一部分病情严重的老年透析患者无法度过透析的头6个月。或许对于这些患者而言，采用不包括开始透析的保守姑息治疗方法会更好。尽管医疗保险和医疗补助服务中心覆盖的人群均可普遍获得临终关怀服务，但透析患者在获得这项福利时遇到了许多障碍，其临终关怀利用率仅为癌症患者的四分之一。本文讨论了慢性肾脏病/终末期肾病患者群体接受姑息治疗的障碍和目标。
