Department of Medicine, University of Washington, Seattle, Washington.
Department of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Kidney360. 2024 Mar 1;5(3):363-369. doi: 10.34067/KID.0000000000000367. Epub 2024 Jan 23.
In the largest survey of US nephrology providers on conservative kidney management (CKM), most reported limited experience with CKM and varied approaches and local resources to provide CKM. There is need to enhance provider training and surveillance of CKM practices and to develop models of CKM that optimize care delivery and outcomes for these patients.
Clinical practice guidelines advocate for conservative kidney management (CKM), a planned, holistic, patient-centered approach to caring for patients who forgo initiation of RRT. Little is known about the extent to which current care practices meet these expectations.
We conducted a cross-sectional survey of a national sample of nephrology providers recruited through US professional societies between March and July 2022 and inquired about their experiences with caring for patients who forgo RRT and their capacity to provide CKM.
Overall, 203 nephrology providers (age 47±12 years, 53.2% White, 66.0% female), of which 49.8% were nephrologists and 50.2% advanced practice providers, completed the survey. Most (70.3%) reported that <10% of their practice comprised patients who had forgone RRT. Most indicated that they always or often provided symptom management (81.8%), multidisciplinary care (68.0%), tools to support shared decision making about treatment of advanced kidney disease (66.3%), and psychological support (52.2%) to patients who forgo RRT, while less than half reported that they always or often provided staff training on the care of these patients (47.8%) and spiritual support (41.4%). Most providers reported always or often working with primary care (72.9%), palliative medicine (68.8%), hospice (62.6%), social work (58.1%), and dietitian (50.7%) services to support these patients, while only a minority indicated that they always or often offered chaplaincy (23.2%), physical and/or occupational therapy (22.8%), psychology or psychiatry (31.5%), and geriatric medicine (28.1%).
Many nephrology providers have limited experience with caring for patients who forgo RRT. Our findings highlight opportunities to optimize comprehensive CKM care for these patients.
在对美国肾脏病学提供者进行的最大规模的保守肾脏管理（CKM）调查中，大多数报告称他们在 CKM 方面经验有限，并且在提供 CKM 方面采用了不同的方法和本地资源。需要加强提供者的培训和对 CKM 实践的监测，并开发优化这些患者护理效果和结果的 CKM 模式。
临床实践指南提倡保守肾脏管理（CKM），这是一种针对放弃开始肾脏替代治疗的患者的计划性、整体性、以患者为中心的护理方法。目前尚不清楚当前的护理实践在多大程度上符合这些期望。
我们对通过美国专业协会于 2022 年 3 月至 7 月招募的全国肾脏病学提供者进行了横断面调查，并询问了他们在照顾放弃肾脏替代治疗的患者方面的经验以及提供 CKM 的能力。
共有 203 名肾脏病学提供者（年龄 47±12 岁，53.2%为白人，66.0%为女性）完成了调查，其中 49.8%为肾脏病专家，50.2%为高级实践提供者。大多数（70.3%）报告称，他们的实践中只有不到 10%的患者放弃了肾脏替代治疗。大多数表示，他们总是或经常为放弃肾脏替代治疗的患者提供症状管理（81.8%）、多学科护理（68.0%）、支持关于晚期肾病治疗的共同决策的工具（66.3%）和心理支持（52.2%），而不到一半的人表示，他们总是或经常为这些患者提供关于护理的员工培训（47.8%）和精神支持（41.4%）。大多数提供者报告说，他们总是或经常与初级保健（72.9%）、姑息治疗（68.8%）、临终关怀（62.6%）、社会工作（58.1%）和营养师（50.7%）合作，以支持这些患者，而只有少数人表示他们总是或经常提供牧师服务（23.2%）、物理和/或职业治疗（22.8%）、心理学或精神病学（31.5%）和老年医学（28.1%）。
许多肾脏病学提供者在照顾放弃肾脏替代治疗的患者方面经验有限。我们的研究结果强调了为这些患者优化全面 CKM 护理的机会。
