终末期肾病：过去 12 个月。
End-stage kidney disease: The last 12 months.
机构信息
MBBS, FRACP, Nephrologist and Advanced Trainee in Palliative Medicine, St George Hospital, Sydney, NSW.
MBBS, DCH, Dip Obs, FRACP, FAChPM, LLB, Palliative Medicine Physician, St George Hospital, Sydney, NSW.
出版信息
Aust J Gen Pract. 2021 Apr;50(4):193-198. doi: 10.31128/AJGP-11-20-5736.
BACKGROUND
Chronic kidney disease (CKD) is increasingly prevalent in Australia's ageing population. Over the past decade, there has been growing recognition that dialysis does not benefit every patient with end-stage kidney disease (ESKD). Patients with advanced age, significant comorbidities and poor functional status may not gain a survival benefit with dialysis when compared with being managed conservatively. These developments have implications for general practitioners (GPs). A further development has been the emergence of renal supportive care, a patient-centred approach that integrates the principles of palliative care into nephrology.
OBJECTIVE
The aim of this article is to outline salient aspects in the care of patients with ESKD.
DISCUSSION
Salient aspects throughout the trajectory of ESKD are discussed, including symptoms of CKD, relevant management, prognostication, advance care planning discussions and end-of-life care. The role of the GP is vital, and it is recommended that GPs are involved early in a patient's CKD trajectory.
背景
慢性肾脏病（CKD）在澳大利亚不断老龄化的人群中越来越普遍。在过去的十年中，人们越来越认识到，透析并不适合每一位终末期肾病（ESKD）患者。与保守治疗相比，年龄较大、合并症较多和功能状态较差的患者进行透析可能无法获得生存获益。这些发展对全科医生（GPs）有影响。另一个发展是出现了肾脏支持性护理，这是一种以患者为中心的方法，将姑息治疗的原则融入肾病学中。
目的
本文旨在概述 ESKD 患者护理的重要方面。
讨论
讨论了 ESKD 整个过程中的重要方面，包括 CKD 的症状、相关管理、预后、预先护理计划讨论和临终关怀。全科医生的作用至关重要，建议全科医生尽早参与患者的 CKD 病程。
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