Renal Research, Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, St. Lucia, Queensland, Australia.
Nephrology (Carlton). 2011 Jan;16(1):4-12. doi: 10.1111/j.1440-1797.2010.01409.x.
Patients with end-stage kidney disease have significantly increased morbidity and mortality. While greater attention has been focused on advanced care planning, end-of-life decisions, conservative therapy and withdrawal from dialysis these must be supported by adequate palliative care incorporating symptom control. With the increase in the elderly, with their inherent comorbidities, accepted onto dialysis, patients, their nephrologists, families and multidisciplinary teams, are often faced with end-of-life decisions and the provision of palliative care. While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well-informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence-based guidelines, core curricula, position statements, standards and tools in palliative care in end-stage kidney disease.
终末期肾病患者的发病率和死亡率显著增加。虽然人们更加关注晚期护理计划、临终决策、保守治疗和停止透析，但这些决策必须得到充分的姑息治疗的支持，包括症状控制。随着老年人口的增加，他们存在固有合并症，被接受进行透析，患者、他们的肾脏科医生、家属和多学科团队经常面临临终决策和提供姑息治疗。虽然与保守治疗相比，透析可能提供更好的生活质量和数量，但情况并非总是如此；因此，在开始这种治疗之前，患者有权了解所有选择和潜在结果。无论选择哪种方案，都应确保他们得到充分的症状控制和姑息治疗。在这一领域没有进行过随机对照试验，只有少数观察性研究提供了指导；因此，预测哪些患者会出现不良结果是有问题的。如果透析患者的功能状态严重恶化，他们可能会受益于充分了解自己在积极治疗和保守治疗之间的选择，并且应该与护理人员分享这些信息。这可以澄清治疗途径，并减少决策方面的模糊性。如果选择保守治疗或停止透析，应通过姑息治疗来支持每一种治疗。本综述的目的是总结终末期肾病姑息治疗方面的已发表研究和循证指南、核心课程、立场声明、标准和工具。
