Isles C, Robertson S, Almond A, Donaldson K, Clark D
Department of Medicine, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland.
J R Coll Physicians Edinb. 2011 Sep;41(3):238-43. doi: 10.4997/JRCPE.2011.313.
The main aim of this review is to let general practitioners and physicians understand what happens to older patients after referral to the renal service. Usually, most patients will be managed completely by the renal team, either because the patient requires dialysis or because conservative but specialised care is appropriate. The recent increase in dialysis rate can mostly be accounted for by older patients for whom such demanding treatment was previously thought to be contraindicated. The decision to dialyse the elderly still remains difficult, with recent data suggesting that if there are significant comorbidities the survival advantage of dialysis in patients over 75 years of age is unlikely to be more than four months. Towards the end of life, conservative treatment is not simply a decision not to dialyse, but comprises active disease management, including treatment of anaemia and other supportive care, which may become increasingly complex, e.g. pain relief with fentanyl and alfentanyl. Older patients who decide to accept dialysis treatment contend with all the usual end of life issues of older people. They have an additional option, denied to the rest of us, of dialysis withdrawal; this effectively allows them to die at a time of their choosing.
本综述的主要目的是让全科医生和内科医生了解老年患者转诊至肾脏科后会发生什么情况。通常，大多数患者将完全由肾脏科团队管理，这要么是因为患者需要透析，要么是因为适合进行保守但专业的护理。近期透析率的上升主要是由老年患者导致的，此前这类要求苛刻的治疗被认为不适用于他们。对老年人进行透析的决策仍然很困难，近期数据表明，如果存在显著的合并症，75岁以上患者接受透析的生存优势不太可能超过四个月。在生命末期，保守治疗不仅仅是决定不进行透析，还包括积极的疾病管理，包括贫血治疗和其他支持性护理，这可能会变得越来越复杂，例如使用芬太尼和阿芬太尼缓解疼痛。决定接受透析治疗的老年患者要应对老年人所有常见的临终问题。他们还有一个我们其他人没有的选择，即停止透析；这实际上使他们能够在自己选择的时间死去。
