Rao Indu Ramachandra, Vallath Nandini, Anupama Y J, Gupta Krishan Lal, Rao Krithika S
Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Division of Palliative Care, National Cancer Grid, India.
Indian J Palliat Care. 2021 May;27(Suppl 1):S6-S10. doi: 10.4103/ijpc.ijpc_61_21. Epub 2021 May 30.
The decision regarding dialysis initiation is complex. Awareness that renal replacement therapy should not be regarded as default therapy for every patient with advanced renal failure is necessary. Decision to initiate dialysis and modality should be individualized in a shared decision-making process involving the treating nephrologist and the patient. Patients should receive predialysis education early in the course of chronic kidney disease so as to help prepare them well in advance for this eventuality. Withholding dialysis may be a reasonable option in a certain subset of patients, especially elderly patient with multiple co-morbid illnesses. Comprehensive conservation care should be offered in all patients where the decision to not dialyze is taken.
关于开始透析的决定很复杂。必须认识到，不应将肾脏替代疗法视为每位晚期肾衰竭患者的默认治疗方法。在由主治肾病专家和患者共同参与的决策过程中，开始透析的决定和透析方式应因人而异。患者应在慢性肾病病程早期接受透析前教育，以便提前为这种可能性做好充分准备。对于某些特定患者群体，尤其是患有多种合并症的老年患者，暂停透析可能是一个合理的选择。对于所有决定不进行透析的患者，都应提供全面的保守治疗。
