Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
Division of Palliative Care, New York University School of Medicine, New York, NY; Division of Nephrology, New York University School of Medicine, New York, NY.
Am J Kidney Dis. 2020 May;75(5):793-806. doi: 10.1053/j.ajkd.2019.10.016. Epub 2020 Mar 12.
Kidney supportive care is the application of palliative medicine principles and practices to patients with kidney disease. The goal is alleviation of suffering through treatment of symptoms, empathic communication, and support for psychosocial distress. Kidney supportive care includes primary palliative care provided by nephrology teams, as well as referral of patients with complex distress for comanagement by an interprofessional specialty palliative care team, when available. The team may include physicians, nurses, social workers, chaplains, and dieticians. Comanagement with nephrologists offers an additional layer of support to patients and families as prognostic awareness, patient preferences, and care decisions are explored. Kidney supportive care can be offered to patients experiencing acute kidney injury or chronic kidney disease, including those with kidney failure treated by kidney replacement therapy (dialysis and transplantation). Kidney supportive care includes but is not limited to end-of-life care. This installment of the Core Curriculum in Nephrology outlines several practical applications of kidney supportive care, with a focus on the nephrologist's approach to symptom management, active medical management of kidney failure without dialysis (also known as comprehensive conservative care), acute kidney injury in seriously ill patients, and withdrawal from dialysis.
肾脏支持治疗是姑息医学原则和实践在肾脏病患者中的应用。其目标是通过治疗症状、共情沟通以及对心理社会困扰的支持来减轻痛苦。肾脏支持治疗包括肾脏病团队提供的初级姑息治疗，以及在有条件的情况下将有复杂困扰的患者转介给跨专业的姑息治疗团队共同管理。团队可能包括医生、护士、社会工作者、牧师和营养师。与肾脏病医生共同管理为患者和家属提供了额外的支持，因为可以探讨预后意识、患者偏好和护理决策。肾脏支持治疗可用于急性肾损伤或慢性肾脏病患者，包括接受肾脏替代治疗（透析和移植）的肾衰竭患者。肾脏支持治疗不仅限于临终关怀。肾脏病核心课程的这一部分概述了肾脏支持治疗的几个实际应用，重点介绍了肾脏病医生对症状管理的方法、在不进行透析的情况下积极进行肾衰竭的医学管理（也称为全面保守治疗）、重病患者的急性肾损伤以及停止透析。
