Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2012 Dec;7(12):2049-57. doi: 10.2215/CJN.03900412. Epub 2012 Sep 20.
Patients with ESRD have extensive and unique palliative care needs, often for years before death. The vast majority of patients, however, dies in acute care facilities without accessing palliative care services. High mortality rates along with a substantial burden of physical, psychosocial, and spiritual symptoms and an increasing prevalence of decisions to withhold and stop dialysis all highlight the importance of integrating palliative care into the comprehensive management of ESRD patients. The focus of renal care would then extend to controlling symptoms, communicating prognosis, establishing goals of care, and determining end-of-life care preferences. Regretfully, training in palliative care for nephrology trainees is inadequate. This article will provide a conceptual framework for renal palliative care and describe opportunities for enhancing palliative care for ESRD patients, including improved chronic pain management and advance care planning and a new model for delivering high-quality palliative care that includes appropriate consultation with specialist palliative care.
终末期肾病患者有广泛而独特的姑息治疗需求，通常在死亡前数年就已存在。然而，绝大多数患者在急性护理机构死亡，无法获得姑息治疗服务。高死亡率，加上大量的身体、心理社会和精神症状负担，以及越来越多的决定停止透析，所有这些都突出了将姑息治疗纳入终末期肾病患者综合管理的重要性。肾脏护理的重点将扩展到控制症状、沟通预后、确定护理目标以及确定临终关怀偏好。遗憾的是，肾病学受训者的姑息治疗培训不足。本文将为肾脏姑息治疗提供一个概念框架，并描述增强终末期肾病患者姑息治疗的机会，包括改善慢性疼痛管理和预先护理计划，以及提供高质量姑息治疗的新模式，包括与专科姑息治疗的适当咨询。
