Lu Emily, Chai Emily
Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Kidney Med. 2021 Dec 2;4(2):100392. doi: 10.1016/j.xkme.2021.10.005. eCollection 2022 Feb.
Individuals receiving peritoneal dialysis (PD)-similar to those receiving hemodialysis -may experience high mortality coupled with a high symptom burden and reduced health-related quality of life. In this context, a discussion of the risks, benefits, and tradeoffs of PD and/or other kidney treatment modalities should be explored based on individual goals and preferences. Through these principles, kidney supportive care provides a person-centered approach to kidney disease care throughout the spectrum of kidney failure and earlier stages of chronic kidney disease. Kidney supportive care is offered in conjunction with life-prolonging therapies, including dialysis and kidney transplants, and is increasingly recognized as an integral part of advancing the care of PD patients. Using "My Kidney Care Roadmap" for shared decision making, kidney supportive care guides patients undergoing PD and their clinicians to (1) elicit patient goals, values, and priorities; (2) convey medical prognosis and suitable treatment options; and (3) ask "Which of these kidney treatment options will best help me achieve my goals and priorities?" to inform both current and future decisions, including choice of dialysis modalities, time-limited trials, and/or nondialysis management. Recognizing that patient priorities and choices may evolve, this framework ultimately allows patients to continually reassess their PD care to better achieve goal-directed dialysis.
接受腹膜透析（PD）的患者——与接受血液透析的患者类似——可能面临高死亡率，同时伴有高症状负担和健康相关生活质量下降。在这种情况下，应根据个人目标和偏好探讨PD和/或其他肾脏治疗方式的风险、益处和权衡。通过这些原则，肾脏支持性护理在肾衰竭及慢性肾脏病早期阶段为肾脏病护理提供了一种以患者为中心的方法。肾脏支持性护理与延长生命的疗法（包括透析和肾移植）相结合提供，并且越来越被视为改善PD患者护理的一个组成部分。使用“我的肾脏护理路线图”进行共同决策，肾脏支持性护理指导接受PD的患者及其临床医生：（1）明确患者的目标、价值观和优先事项；（2）传达医学预后和合适的治疗选择；（3）询问“这些肾脏治疗选择中哪一种最有助于我实现目标和优先事项？”，以告知当前和未来的决策，包括透析方式的选择、限时试验和/或非透析管理。认识到患者的优先事项和选择可能会演变，这一框架最终使患者能够不断重新评估其PD护理，以更好地实现目标导向的透析。
