Hutchison Alastair J, Courthold Jonathan J
Manchester Institute of Nephrology & Transplantation, The Royal Infirmary, Manchester, UK.
NDT Plus. 2011 Dec;4(Suppl 3):iii7-iii10. doi: 10.1093/ndtplus/sfr151.
Pre-emptive living donor transplantation should always be promoted as the first-line treatment for kidney failure. Where that is not possible, patients must receive timely information and advice regarding all dialysis options available, including home-based peritoneal dialysis and haemodialysis. Where a dialysis unit enables and actively encourages self-management, patients will tend to select themselves, and if well motivated may overcome significant difficulties to exceed the expectations or predictions of dialysis staff. Patients then become advocates themselves and can provide other patients with the necessary motivation to consider a home treatment, such that they approach staff, rather than vice versa. For staff to be able to talk to patients with confidence requires direct experience of home dialysis, but in units which do not have a full range of home therapies, this may initially be difficult. Visiting patients in their home environment is an essential part of training for both medical and nursing staff. Before a patient is able to begin to engage in discussion about any dialysis therapy, they must have reached a point of acceptance that dialysis is necessary. If they are not at this point, then any attempt at 'education' will be largely futile. Once a patient has arrived at the point of choosing a home therapy, the pathway to their first dialysis at home must be as smooth and problem-free as possible.
应始终倡导优先进行活体供体移植，将其作为肾衰竭的一线治疗方法。如果无法进行活体供体移植，患者必须及时获得有关所有可用透析选项的信息和建议，包括家庭腹膜透析和血液透析。如果透析单位能够并积极鼓励自我管理，患者往往会自行选择，如果积极性高，可能会克服重大困难，超出透析工作人员的预期或预测。患者随后会成为倡导者，能够为其他患者提供考虑家庭治疗的必要动力，从而使他们主动与工作人员交流，而不是相反。工作人员要能够自信地与患者交谈，需要有家庭透析的直接经验，但在没有全套家庭治疗方法的单位，这一开始可能会很困难。到患者家中探访是医护人员培训的重要组成部分。在患者能够开始讨论任何透析治疗之前，他们必须已经接受透析是必要的这一事实。如果他们还没有达到这一点，那么任何“教育”尝试都将基本徒劳无功。一旦患者到达选择家庭治疗的阶段，他们在家中首次进行透析的流程必须尽可能顺利且没有问题。
