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停止透析:原因与时机?

Withdrawal from Dialysis: Why and When?

作者信息

Bhojaraja Mohan V, Singhai Pankaj, Sunil Kumar M M, Sreelatha M

机构信息

Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

出版信息

Indian J Palliat Care. 2021 May;27(Suppl 1):S30-S32. doi: 10.4103/ijpc.ijpc_66_21. Epub 2021 May 30.

Abstract

Patients with end-stage kidney diseases may request for withdrawal of dialyses for many reasons. Healthcare practitioners frequently puzzled by ethical dilemma of respecting patient's wishes and beneficence of continuing dialysis. Shared decision-making and negotiating goal of care help in decision-making in patients' interests. Proactive identification guidelines that may be used for screening help in weighing options of dialysis and conservative care during progressive decline of clinical condition. Proactive identification guidelines may be used for screening. It helps in weighing options of dialysis versus conservative care during progressive decline of clinical condition. An individualized, patientcentred discussion, rather than disease-oriented, approach may be adapted.

摘要

终末期肾病患者可能因多种原因要求停止透析。医护人员常常对尊重患者意愿与继续透析的益处这一伦理困境感到困惑。共同决策和协商护理目标有助于做出符合患者利益的决策。在临床状况逐渐恶化期间,可用于筛查的主动识别指南有助于权衡透析和保守治疗的选择。主动识别指南可用于筛查。它有助于在临床状况逐渐恶化期间权衡透析与保守治疗的选择。可以采用个性化的、以患者为中心的讨论方式,而不是以疾病为导向的方式。

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本文引用的文献

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Factors influencing withdrawal from dialysis: a national registry study.影响透析撤机的因素:一项全国性登记研究。
Nephrol Dial Transplant. 2016 Dec;31(12):2041-2048. doi: 10.1093/ndt/gfw074. Epub 2016 Apr 21.
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Dying on dialysis: the case for a dignified withdrawal.在透析中离世:尊严撤机的理由
Clin J Am Soc Nephrol. 2014 Jan;9(1):174-80. doi: 10.2215/CJN.05730513. Epub 2013 Aug 22.
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The ethics of end-of-life care for patients with ESRD.终末期肾病患者的临终关怀伦理。
Clin J Am Soc Nephrol. 2012 Dec;7(12):2049-57. doi: 10.2215/CJN.03900412. Epub 2012 Sep 20.

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