Burns Aine, Davenport Andrew
UCL Center for Nephrology, University College London Medical School, London, UK.
Hemodial Int. 2010 Oct;14 Suppl 1:S32-7. doi: 10.1111/j.1542-4758.2010.00488.x.
Following the expansion of dialysis services for patients with chronic kidney disease, an increasing number of elderly patients with varying degrees of frailty and additional comorbidities have been offered treatment. Life expectancy is somewhat limited in this group of patients, and initiation of dialysis may not necessarily improve quality of life. As such, an increasing number of centers are offering conservative care for patients who have made an informed decision not to have dialysis. As conservative care includes active treatment of anemia, volume overload, blood pressure control, and management of uremic symptoms, including pruritus, we term this approach as maximal conservative management of chronic kidney disease. We describe our experience of maximum conservative management, which although may not prolong life, can maintain the quality of life and functional ability until the final illness in the majority of patients. Although these patients do not go to the hospital on a regular basis, coordinated support from the hospital, the community, and the care giver/relative is required for successful care of the patient. Appropriate end of life planning can then be made according to the wishes of the patient.
随着慢性肾病患者透析服务的扩展，越来越多不同程度虚弱且伴有其他合并症的老年患者接受了治疗。这组患者的预期寿命有所受限，开始透析不一定能改善生活质量。因此，越来越多的中心为已做出不进行透析的明智决定的患者提供保守治疗。由于保守治疗包括积极治疗贫血、容量超负荷、控制血压以及管理尿毒症症状（包括瘙痒），我们将这种方法称为慢性肾病的最大保守管理。我们描述了我们最大保守管理的经验，尽管这可能无法延长生命，但在大多数患者中可以维持生活质量和功能能力直至终末期疾病。尽管这些患者不定期去医院，但要成功护理患者需要医院、社区以及护理人员/亲属的协调支持。然后可以根据患者的意愿进行适当的临终规划。
