Vanderbilt University Medical Center, Division of Nephrology and Hypertension.
Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee.
Curr Opin Nephrol Hypertens. 2021 Mar 1;30(2):190-197. doi: 10.1097/MNH.0000000000000689.
Using case vignettes, we highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the coronavirus disease-19 (COVID-19) pandemic for patients with kidney disease. We include best practice recommendations to mitigate these issues and conclude with implications for interdisciplinary models of care in crisis settings.
Certain biomarkers, demographics, and medical comorbidities predict an increased risk for mortality among patients with COVID-19 and kidney disease, but concerns related to physical exposure and conservation of personal protective equipment have exacerbated existing barriers to empathic communication and value clarification for these patients. Variability in patient characteristics and outcomes has made prognostication nuanced and challenging. The pandemic has also highlighted the complexities of dialysis decision-making for older adults at risk for poor outcomes related to COVID-19.
The COVID-19 pandemic underscores the need for nephrologists to be competent in serious illness communication skills that include virtual and remote modalities, to be aware of prognostic tools, and to be willing to engage with interdisciplinary teams of palliative care subspecialists, intensivists, and ethicists to facilitate goal-concordant care during crisis settings.
通过病例分析，我们强调了在冠状病毒病-19（COVID-19）大流行期间，沟通、预后和医疗决策方面的挑战因肾病患者而加剧。我们包括了减轻这些问题的最佳实践建议，并以危机环境中跨学科护理模式的影响作为结论。
某些生物标志物、人口统计学特征和合并症使 COVID-19 合并肾病患者的死亡率风险增加，但与身体暴露和个人防护设备的保护有关的问题加剧了对这些患者进行同理心沟通和价值澄清的现有障碍。患者特征和结局的可变性使得预后变得复杂和具有挑战性。大流行还凸显了老年高危 COVID-19 不良结局患者进行透析决策的复杂性。
COVID-19 大流行强调了肾脏病专家需要具备包括虚拟和远程模式在内的严重疾病沟通技能，了解预后工具，并愿意与姑息治疗专家、重症监护专家和伦理学家的跨学科团队合作，以便在危机环境中促进目标一致的护理。
