Division of Nephrology and Dialysis, Santa Chiara Hospital, Trento, Italy,
Department of Medicine, University of Perugia, Perugia, Italy.
Kidney Blood Press Res. 2021;46(1):11-16. doi: 10.1159/000512629. Epub 2021 Jan 29.
The recent coronavirus disease 2019 (CO-VID-19) pandemic has placed worldwide health systems and hospitals under pressure, and so are the renal care models. This may be a unique opportunity to promote and expand alternative models of health-care delivery in patients undergoing renal replacement therapies.
Despite the high risk of acquiring communicable diseases when undergoing in-centre treatments, only a small proportion of patients are currently being treated with home therapies. Recent data provided by the Italian Society of Nephrology (SIN), the REIN French Registry and the Wuhan Hemodialysis Quality Control Center clearly show that patients receiving hospital-based treatment have a 3- to 4-fold greater risk of infection, and a subsequent fatality proportion between 21 and 34%. On the other hand, home-based therapy can be managed remotely, there is little or no need for transport to and from the hospital, and it is less expensive. Besides, the digital revolution in health care with the development of virtual care systems can make home dialysis with telehealth a cost-effective solution for both patients and health-care providers. Such a transition would require specific training for physicians and health-care professionals and a functional re-organization of dialysis centres to improve the skills and expertise in caring for patients at home.
The need for more widespread home treatment is the main lesson learnt by nephrologists by the COVID-19 pandemic.
最近的 2019 年冠状病毒病（COVID-19）大流行给全球卫生系统和医院带来了压力，肾脏护理模式也是如此。这可能是一个独特的机会，可以在接受肾脏替代治疗的患者中推广和扩大替代医疗保健模式。
尽管在接受中心治疗时感染传染病的风险很高，但目前只有一小部分患者正在接受家庭治疗。最近意大利肾脏病学会（SIN）、法国 REIN 登记处和武汉血液透析质量控制中心提供的最新数据清楚地表明，接受医院治疗的患者感染的风险增加了 3 到 4 倍，随后的死亡率在 21%至 34%之间。另一方面，家庭治疗可以远程管理，几乎不需要往返医院，而且成本更低。此外，随着虚拟护理系统的发展，医疗保健领域的数字化革命可以使远程医疗家庭透析成为患者和医疗保健提供者的一种具有成本效益的解决方案。这种转变需要对医生和医疗保健专业人员进行特定的培训，并对透析中心进行功能重组，以提高在家中照顾患者的技能和专业知识。
COVID-19 大流行让肾病学家吸取的主要教训是需要更广泛地开展家庭治疗。
