Talia Alster, Reshit Beizer, Daniel Azulay
Hadassah University Medical Center, Jerusalem, Israel.
Case Rep Nephrol. 2025 Apr 18;2025:7796641. doi: 10.1155/crin/7796641. eCollection 2025.
This report details the remarkable improvement in kidney function and quality of life in an ESKD 93-year-old male patient under conservative management in Israel. The patient, with previous postrenal obstruction due to prostate enlargement and recurring infections, exhibited significant kidney deterioration, reaching a creatinine level of 7.6 mg/dL and a GFR of 6.7 mL/min/1.73 m in December 2023. Following numerous hospitalizations and ER visits over the previous year, the patient opted for palliative care, prioritizing life quality over life-extending interventions. Over a 6 month period (December 2023-May 2024), the patient received comprehensive palliative care: nurse visits, bimonthly doctor consultations, and medication adjustments based on biochemical home blood tests. Despite initial severe kidney impairment, the patient's creatinine levels improved to 3.2 mg/dL and GFR increased to 18.2 mL/min/1.73 m. Potassium and phosphorus stabilized, and no further ER visits were recorded. Clinically, the patient showed enhanced cognition, memory, and communication and managed peripheral edema effectively. This case underscores the potential benefits of conservative palliative management in an Israeli elderly patient, a phenomenon that is recognized in the US and Canada more often, but not highlighted in the Middle Eastern elderly population. Coordinated efforts of a skilled palliative care team and supportive home hospice care contributed to the patient's clinical improvement. These findings challenge the notion that is often communicated to Israeli ESKD patients, Hatoum and Sperling, that palliative treatment leads to further kidney function deterioration, suggesting that, in some cases, it can result in improved outcomes in an underreported population.
本报告详细介绍了以色列一名93岁终末期肾病男性患者在保守治疗下肾功能和生活质量的显著改善。该患者曾因前列腺肿大导致肾后梗阻并反复感染，肾功能严重恶化，2023年12月肌酐水平达到7.6mg/dL，肾小球滤过率（GFR）为6.7mL/min/1.73m²。在过去一年多次住院和急诊就诊后，患者选择了姑息治疗，将生活质量置于延长生命的干预措施之上。在6个月期间（2023年12月至2024年5月），患者接受了全面的姑息治疗：护士家访、每两个月一次的医生会诊以及根据家庭生化血液检测结果进行的药物调整。尽管最初肾功能严重受损，但患者的肌酐水平改善至3.2mg/dL，GFR升至18.2mL/min/1.73m²。钾和磷水平稳定，未再记录到急诊就诊情况。临床上，患者认知、记忆和沟通能力增强，有效控制了外周水肿。该病例强调了以色列老年患者保守姑息治疗的潜在益处，这种现象在美国和加拿大更为常见，但在中东老年人群体中未得到充分重视。专业姑息治疗团队的协同努力和支持性的家庭临终关怀护理促成了患者的临床改善。这些发现挑战了通常传达给以色列终末期肾病患者（哈图姆和斯珀林）的观念，即姑息治疗会导致肾功能进一步恶化，表明在某些情况下，它可以在一个未得到充分报道的人群中带来更好的结果。
