Da Silva-Gane Maria, Farrington Ken
Renal Unit, Lister Hospital, E&N Herts NHS Trust, Stevenage, Hertfordshire, UK.
J Ren Care. 2014 Sep;40 Suppl 1:30-5. doi: 10.1111/jorc.12093.
Treatment with dialysis has benefitted large numbers of patients with advanced kidney disease. It is though highly intrusive and demanding and some elderly, frail patients may tolerate it poorly. Some of these patients who are either approaching 'end-stage' kidney disease or 'failing' despite being on dialysis may choose to pursue supportive or palliative approaches, partially or fully replacing the dialysis option. Here, we describe some of the challenges confronting these patients and present data on the attitudes and perceptions to supportive care and end-of-life care planning of patients on haemodialysis including some whose prognosis was poor. The main focus for these patients appeared to be on holding on to what they had, adapting by living 'from day to day' in the present, and continuing to hope for the best. Advance care planning was seen as potentially useful by patients, once clarity surrounding its purpose had been established.
透析治疗使大量晚期肾病患者受益。然而，透析极具侵入性且要求苛刻，一些老年体弱患者可能耐受性较差。这些患者中，有些虽已接近“终末期”肾病，或尽管接受透析但仍“病情恶化”，他们可能会选择采取支持性或姑息性治疗方法，部分或完全取代透析治疗。在此，我们描述了这些患者面临的一些挑战，并展示了血液透析患者对支持性护理和临终护理计划的态度及看法的数据，其中包括一些预后较差的患者。这些患者的主要关注点似乎是保住他们所拥有的，通过“日复一日”地活在当下进行调整，并继续抱最好的希望。一旦明确了预先护理计划的目的，患者就认为它可能有用。
