Koshy A N, Mace R, Youl L, Challenor S, Bull R, Fassett R G
Department of Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
Indian J Nephrol. 2012 Jul;22(4):307-9. doi: 10.4103/0971-4065.101263.
With increased numbers of the elderly, including nursing home patients, being accepted for end-stage kidney disease (ESKD) management, there is heightened interest and focus on end of life decisions, advanced care planning and directives, withdrawal from dialysis and palliative care in this setting. Despite this, care at the individual patient level can vary greatly. Here, we present two contrasting cases to highlight the importance of early and ongoing involvement of palliative care in patients with ESKD. In the first case, a high quality of life was preserved before the patient died with dignity, with early interdisciplinary palliative care involvement. In the second case there was a long protracted period of poor quality of life prior to death. This was associated with resistance to the involvement of palliative care, mainly from the family. Addressing end of life care issues early in the chronic kidney disease (CKD) trajectory and ensuring patients, their families and health care providers are well informed, may contribute to a better outcome for the patient and their family.
随着越来越多的老年人，包括养老院患者，被纳入终末期肾病（ESKD）管理，人们对临终决策、高级护理计划和指示、停止透析以及这种情况下的姑息治疗的兴趣和关注度日益提高。尽管如此，个体患者层面的护理差异可能很大。在此，我们呈现两个截然不同的案例，以突出姑息治疗在ESKD患者中早期及持续参与的重要性。在第一个案例中，由于姑息治疗团队早期的跨学科参与，患者在有尊严地离世前保持了较高的生活质量。在第二个案例中，患者在死亡前经历了很长一段时间的低质量生活。这与主要来自家庭对姑息治疗参与的抵触有关。在慢性肾病（CKD）病程早期解决临终护理问题，并确保患者、其家人和医疗服务提供者充分了解情况，可能有助于患者及其家人获得更好的结果。
