Marsh Seren, Varghese Amanda, Snead Charlotte M, Hole Barnaby D, O'Hara Daniel V, Agarwal Neeru, Stallworthy Elizabeth, Caskey Fergus J, Smyth Brendan J, Ducharlet Kathryn
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia.
Kidney Int Rep. 2024 May 4;9(7):2198-2208. doi: 10.1016/j.ekir.2024.04.055. eCollection 2024 Jul.
Kidney supportive care (KSC) integrates kidney and palliative care to improve quality of life for people with chronic kidney disease (CKD). Despite increasing interest and global advocacy to integrate KSC into kidney care, evidence to guide optimal care delivery is limited.
This observational cross-sectional study used an online survey to describe current KSC models in Australia, Aotearoa-New Zealand, and the UK.
Between April and December 2022, 114 nephrology units responded (response rate 67%), with 66% having a dedicated KSC service (UK, 74%; Australia, 58%; and New Zealand, 67%). Many different health care professionals worked in KSC services with diversity in clinical resources and activities between units and across countries. Overall, funding for KSC services was low, with a median full time equivalent (FTE) per unit (standardized per 100 people receiving hemodialysis [HD]) of 0.51 (interquartile range [IQR], 0.17-1.05) and 4 units provided a service without allocated funding. The scope of KSC service was wide-ranging and prioritized activities included symptom management, psychological support, complex future treatment planning and discussion, and care coordination. There were no significant differences between countries in terms of location of care provision, frequency of review, referral patterns or discharge rates; however, there was variation described within countries.
Models of KSC vary markedly across kidney units and between countries. Despite this variation, there was consistency in terms of clinical priorities which were person-centered and focused on physical and psychosocial well-being. Further research is required to evaluate the effectiveness of KSC provision, alongside improved funding methods to ensure sustainable and equitable KSC delivery.
肾脏支持性护理（KSC）将肾脏护理与姑息治疗相结合，以提高慢性肾脏病（CKD）患者的生活质量。尽管将KSC纳入肾脏护理的兴趣日益浓厚且得到全球倡导，但指导最佳护理提供的证据有限。
这项观察性横断面研究使用在线调查来描述澳大利亚、新西兰和英国目前的KSC模式。
在2022年4月至12月期间，114个肾脏病科做出了回应（回应率67%），其中66%设有专门的KSC服务（英国，74%；澳大利亚，58%；新西兰，67%）。许多不同的医疗保健专业人员参与KSC服务，各单位之间以及不同国家之间的临床资源和活动存在差异。总体而言，KSC服务的资金投入较低，每个单位的全职等效人员（FTE）中位数（按每100名接受血液透析[HD]的患者标准化）为0.51（四分位间距[IQR]，0.17 - 1.05），有4个单位提供服务但没有分配资金。KSC服务范围广泛，优先开展的活动包括症状管理、心理支持、复杂的未来治疗规划与讨论以及护理协调。在护理提供地点、复查频率、转诊模式或出院率方面，各国之间没有显著差异；然而，各国国内存在差异描述。
KSC模式在不同肾脏单位之间以及不同国家之间存在显著差异。尽管存在这种差异，但在以患者为中心、关注身体和心理社会福祉的临床重点方面存在一致性。需要进一步研究以评估KSC提供的有效性，同时改进资金筹集方法，以确保可持续和公平的KSC服务提供。
