Pinto Andrea
Nursing, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira (SESARAM) Entidade Pública Empresarial Regional Autónoma da Madeira (EPERAM), Funchal, PRT.
Cureus. 2025 Mar 31;17(3):e81487. doi: 10.7759/cureus.81487. eCollection 2025 Mar.
With the aging of the population and better healthcare, more elderly and frail patients are reaching the terminal stage of chronic kidney disease (CKD). In Portugal, one of the European leaders in the incidence of renal function replacement therapy, hemodialysis and peritoneal dialysis continue to be the focus of treatment, even in patients with multiple comorbidities, low functional reserve, and care dependency. However, several studies have revealed that these therapies in fragile patients do not provide quality of life or a greater survival rate but are associated with increased suffering due to the loss of functional capacity, with a subsequent need to abandon dialysis. Nephrology nursing in Portugal has always followed this more technical aspect necessary for dialysis. However, it has not dedicated itself to conservative treatment or other nephrology areas requiring differentiated palliative care, such as cardiorenal syndrome (CRS). Conservative treatment is a valid alternative that corresponds to the continuation of comprehensive therapy for patients with CKD without resorting to dialysis techniques. It seeks to prevent the deterioration of residual renal function while alleviating symptoms and complications resulting from disease progression, with personalized palliative care support aimed at optimizing the physical, emotional, and spiritual well-being of the patient and their family. On the other hand, despite being palliative, patients with CRS can benefit from more invasive techniques such as assisted peritoneal ultrafiltration to control symptoms, along with an educational approach that promotes their empowerment. This need for a paradigm shift led us to implement a specific nursing consultation for conservative treatment and CRS, ensuring personalized monitoring of these illnesses. Palliative care must be an integral part of healthcare, not only for incurable and terminal diseases but also for chronic, advanced, and evolving conditions.
随着人口老龄化和医疗保健水平的提高，越来越多的老年体弱患者正步入慢性肾脏病（CKD）终末期。在葡萄牙，作为肾功能替代治疗发病率位居欧洲前列的国家之一，血液透析和腹膜透析仍是治疗的重点，即便对于患有多种合并症、功能储备低且需要护理依赖的患者也是如此。然而，多项研究表明，这些疗法对于体弱患者而言，并未带来生活质量的提升或更高的生存率，反而因功能能力丧失导致痛苦增加，进而需要放弃透析。葡萄牙的肾脏病护理一直侧重于透析所需的技术层面。然而，它并未致力于保守治疗或其他需要差异化姑息治疗的肾脏病领域，如心肾综合征（CRS）。保守治疗是一种有效的替代方案，适用于不借助透析技术而继续接受全面治疗的CKD患者。它旨在防止残余肾功能恶化，同时缓解疾病进展导致的症状和并发症，并提供个性化的姑息治疗支持，以优化患者及其家人的身体、情感和精神健康。另一方面，尽管CRS患者需要姑息治疗，但他们可以从更具侵入性的技术（如辅助腹膜超滤以控制症状）以及促进其自主能力的教育方法中获益。这种范式转变的需求促使我们实施针对保守治疗和CRS的特定护理咨询，确保对这些疾病进行个性化监测。姑息治疗必须成为医疗保健不可或缺的一部分，不仅适用于无法治愈的终末期疾病，也适用于慢性、晚期和不断发展的病症。
