Raghavan Divya, Holley Jean L
Department of Medicine, University of Illinois, Urbana-Champaign, IL; and Carle Physician Group, Urbana, IL.
Department of Medicine, University of Illinois, Urbana-Champaign, IL; and Carle Physician Group, Urbana, IL.
Adv Chronic Kidney Dis. 2016 Jan;23(1):51-6. doi: 10.1053/j.ackd.2015.08.003.
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life. Patients with advanced CKD have a high symptom burden that often worsens before death. Palliative or supportive care by visiting nurses, palliative care programs, or knowledgeable CKD programs should be routine for conservatively managed CKD patients. Decision-making about dialysis or conservative management requires patients and families be given information on prognosis, quality of life on dialysis, and options for supportive care. Advance care planning is the process by which these issues can be explored. In addition to advance care planning, because patients with ESRD have a high symptom burden, this needs to be addressed. Patients with ESRD have a high symptom burden, which needs to be addressed in any treatment plan. Common symptoms include pain, fatigue, insomnia, pruritus, anorexia, and nausea. Symptoms appear to increase as the patient nears death, and this must be anticipated. Recommendations for management are discussed in the article. Hospice care should be offered to all patients who are expected to die within the next 6 months, and supportive care should be provided to all CKD patients managed conservatively or with dialysis.
姑息治疗是医学的一个分支，致力于缓解疾病过程中出现的症状。肾脏姑息医学或肾脏支持护理是肾脏病学中一个不断发展的分支，它将姑息治疗的原则纳入慢性肾脏病（CKD）和终末期肾病（ESRD，包括透析、移植和保守治疗）患者的护理中。对于体弱的老年CKD患者，保守（非透析）治疗是一种合理的选择，因为透析可能无法改善其生活质量或延长寿命。晚期CKD患者的症状负担很重，且往往在死亡前加重。对于接受保守治疗的CKD患者，由访视护士、姑息治疗项目或知识丰富的CKD项目提供姑息或支持性护理应成为常规。关于透析或保守治疗的决策需要向患者及其家属提供有关预后、透析生活质量和支持性护理选择的信息。预先护理计划是探讨这些问题的过程。除预先护理计划外，由于ESRD患者的症状负担很重，这一问题需要得到解决。ESRD患者的症状负担很重，在任何治疗计划中都需要加以解决。常见症状包括疼痛、疲劳、失眠、瘙痒、厌食和恶心。随着患者接近死亡，症状似乎会加重，对此必须有所预期。本文讨论了管理建议。对于预计在未来6个月内死亡的所有患者都应提供临终关怀，对于所有接受保守治疗或透析治疗的CKD患者都应提供支持性护理。
