Martino Francesca K, Novara Giacomo, Nalesso Federico, Calò Lorenzo A
Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy.
Department of Surgery, Oncology and Gastroenterology, Urology Clinic University of Padua, 35124 Padua, Italy.
J Clin Med. 2023 Dec 21;13(1):41. doi: 10.3390/jcm13010041.
In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.
在过去几十年中，普通人群的老龄化显著增加了需要肾脏替代治疗的终末期肾病（ESKD）老年患者的数量。ESKD老年患者通常身体虚弱，伴有多种严重的社会问题，而且从生存和生活质量方面来看，透析对他们似乎并无益处。保守治疗（CM）可能是一种有效的治疗选择，能让他们在对生活习惯影响较小的情况下存活数月至数年。尽管有这些潜在优势，但由于存在一种误解，即认为透析是所有ESKD患者唯一有效的治疗选择，而不论其对生活质量和生存的影响如何，所以CM的使用仍然不足。CM和透析在ESKD的管理中都是有效的替代方案。然而，评估合并症、残疾情况和社会背景应指导为ESKD选择最佳治疗方案，而对于预期寿命较短的老年患者，将他们转诊至姑息治疗似乎是最合理的选择。
