Dharmagunawardene Dilantha, Kularatna Sanjeewa, Halahakone Ureni, Purtell Louise, Bonner Ann, Healy Helen G, Senanayake Sameera
School of Applied Psychology, Griffith Health, Griffith University, South Bank Campus, Brisbane, Australia.
Ministry of Health, Colombo, Sri Lanka.
J Ren Care. 2025 Mar;51(1):e12517. doi: 10.1111/jorc.12517.
Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.
To identify and appraise evidence-based health system kidney supportive care interventions DESIGN: Systematic review (PROSPERO Registration - CRD42022333650).
Adults with chronic kidney failure.
Six databases were searched, using terms "palliative care" and "chronic kidney disease" for publications between January 2010 and March 2024. The Cochrane "Effective Practice and Organisation of Care" and "Clinical Practice Guidelines for Quality Palliative Care" domains informed data extraction.
Of the 60 studies included, one-third were randomised controlled trials. The most common "Effective Practice and Organisation of Care" domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described "Clinical Practice Guidelines for Quality Palliative Care" domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.
The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.
肾衰竭可以通过保守治疗或肾脏替代疗法进行管理。肾脏支持性护理将肾脏病学专业知识与姑息治疗相结合，由多学科团队提供，重点是提高生活质量。
识别并评估基于证据的卫生系统肾脏支持性护理干预措施。
系统评价（PROSPERO注册编号 - CRD42022333650）。
成年慢性肾衰竭患者。
检索了六个数据库，使用“姑息治疗”和“慢性肾脏病”等术语查找2010年1月至2024年3月期间的出版物。Cochrane“有效护理实践与组织”和“优质姑息治疗临床实践指南”领域为数据提取提供了依据。
纳入的60项研究中，三分之一为随机对照试验。最常描述的“有效护理实践与组织”领域是护理提供（58/60）。临终护理（33/60）和护理的身体方面（19/60）是常见的“优质姑息治疗临床实践指南”领域。26项研究强调了多学科共享护理。描述最少的领域是文化方面（0/60）和伦理方面（3/60）。近三分之二（39/60）的研究比较了肾脏支持性护理干预措施的结果，评估的最常见结果是预先护理计划（18/39）。报告的主要发现是综合姑息治疗减少了住院次数和费用，促进了更好的医患沟通，并改善了症状管理。在护理的文化和伦理/法律方面发现了差距。
这些研究强调了肾脏支持性护理干预措施在改善患者结局方面的有效性，特别是在临终护理和症状管理方面。然而，已发现的重大现有差距需要进一步研究。
