Wearne Nicola, Davidson Bianca, Motsohi Ts'epo, Mc Culloch Mignon, Krause Rene
Division of Nephrology and Hypertension, Groote Schuur Hospital, Nephrology and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.
Division of Family Medicine in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Kidney Int Rep. 2020 Dec 7;6(3):568-573. doi: 10.1016/j.ekir.2020.11.024. eCollection 2021 Mar.
The incidence of end-stage kidney disease (ESKD) is increasing worldwide; however, because of resource constraints, access to lifesaving kidney replacement therapy (KRT) remains limited in the state sector in South Africa. National guidelines mandate that only patients who are transplantable be accepted into state chronic dialysis programs. Once a patient is transplanted, there is an opportunity for a new patient to access a chronic dialysis slot. Given the resource scarcity, the South African Constitutional Court has ruled that rationing of dialysis is appropriate; however, this is not without cost both to patients and decision makers. Patients, both adults and pediatric, are often placed on a palliative care (PC) pathway not through choice but through circumstance. Renal supportive care (RSC) and PC involve an interdisciplinary approach to manage patients with ESKD to ensure that symptoms are managed optimally and to provide support during advanced disease. Innovative ways to address patient care at any age must be sought to ensure nonabandonment and adequate care with our limited resources.
终末期肾病（ESKD）的发病率在全球范围内呈上升趋势；然而，由于资源限制，在南非的国家部门，获得挽救生命的肾脏替代疗法（KRT）的机会仍然有限。国家指南规定，只有可移植的患者才能被纳入国家慢性透析项目。一旦患者接受了移植，就会有新的患者有机会获得慢性透析名额。鉴于资源稀缺，南非宪法法院裁定透析配给是合适的；然而，这对患者和决策者来说都并非没有代价。成人和儿童患者往往不是出于选择，而是由于环境因素而被置于姑息治疗（PC）路径上。肾脏支持性护理（RSC）和PC涉及一种跨学科方法，用于管理ESKD患者，以确保症状得到最佳管理，并在疾病晚期提供支持。必须寻求创新方法来解决任何年龄段患者的护理问题，以确保在资源有限的情况下不抛弃患者并提供充分护理。
