Berar Yanay Noa, Hochman Ohad
Nephrology Institute, Hillel Yaffe Medical Center.
Management Department, Hillel Yaffe Medical Center.
Harefuah. 2019 Jan;158(1):48-52.
The number of dialysis patients is consistently growing and the dialysis population is aging. Of all age groups of dialysis patients, the higher prevalence rate is in the elderly group (aged 75 years and older). The elderly patients have a high rate of comorbidities. Chronic dialysis treatment is expected to prolong survival. Older age and comorbidities are among the most powerful prognostic factors for survival on chronic dialysis. Observational studies found that after adjustment for age and comorbidities, dialysis treatment does not confer survival advantage when compared to conservative management in elderly patients with multiple comorbidities. Comprehensive conservative management is targeted for those patients who are not expected to benefit from chronic dialysis. The focus is on patients' preferences, specifically regarding issues of quality of life, and not necessarily on prolonging survival. For this process, shared decision-making is the recommended strategy. The rate of patients who opt for conservative management varies between countries. There is no data from Israel in this regard, but it is assumed that the conservative option is underutilized. There are different reasons for the current situation, factors that: depend on the caregivers' side, are patient dependent, relate to the health care system and available services and some cultural aspects. Addressing these gaps may require further collection of data, construction of needed services for conservative management and education of the caregivers and the patients.
透析患者数量持续增长，且透析人群正趋于老龄化。在所有年龄段的透析患者中，老年组（75岁及以上）的患病率更高。老年患者合并症发生率高。慢性透析治疗有望延长生存期。高龄和合并症是慢性透析患者生存的最有力预后因素之一。观察性研究发现，在对年龄和合并症进行调整后，对于患有多种合并症的老年患者，与保守治疗相比，透析治疗并未带来生存优势。综合保守治疗针对那些预计无法从慢性透析中获益的患者。重点在于患者的偏好，特别是关于生活质量问题，而不一定是延长生存期。对于这个过程，推荐采用共同决策策略。选择保守治疗的患者比例在不同国家有所不同。以色列在这方面没有相关数据，但据推测保守治疗选项未得到充分利用。造成当前这种情况有不同原因，这些因素包括：取决于护理人员方面、取决于患者自身、与医疗保健系统及可用服务有关以及一些文化方面。解决这些差距可能需要进一步收集数据、构建保守治疗所需服务以及对护理人员和患者进行教育。
