Conservative care in Europe-nephrologists' experience with the decision not to start renal replacement therapy

被引:54
作者
van de Luijtgaarden, Moniek W. M. [1 ]
Noordzij, Marlies [1 ]
van Biesen, Wim [2 ]
Couchoud, Cecile [3 ]
Cancarini, Giovanni [4 ,5 ]
Bos, Willem-Jan W. [6 ]
Dekker, Friedo W. [7 ]
Gorriz, Jose L. [8 ]
Iatrou, Christos [9 ]
Wanner, Christoph [10 ]
Finne, Patrik [11 ,12 ]
Stojceva-Taneva, Olivera [13 ]
Cala, Svjetlana [14 ]
Stel, Vianda S. [1 ]
Tomson, Charles [15 ]
Jager, Kitty J. [1 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, ERA EDTA Registry, Dept Med Informat, NL-1105 AZ Amsterdam, Netherlands
[2] Ghent Univ Hosp, Renal Div, Ghent, Belgium
[3] REIN Registry, Biomed Agcy, La Plaine St Denis, France
[4] Spedali Civil Brescia, I-25125 Brescia, Italy
[5] Univ Brescia, Brescia, Italy
[6] St Antonius Hosp, Dept Internal Med, Nieuwegein, Netherlands
[7] Leiden Univ, Med Ctr, Dept Clin Epidemiol, Leiden, Netherlands
[8] Hosp Univ Dr Peset, Dept Nephrol, Valencia, Spain
[9] Gen Hosp Nikaia Pireaus, Ctr Nephrol G Papadakis, Piraeus, Greece
[10] Univ Hosp Wurzburg, Div Nephrol, Wurzburg, Germany
[11] Helsinki Univ Cent Hosp, Div Nephrol, Helsinki, Finland
[12] Finnish Registry Kidney Dis, Helsinki, Finland
[13] Univ Clin Nephrol, Skopje, Macedonia
[14] Univ Zagreb, Sch Med, Sestre Milosrdnice Clin Hosp, Nephrol & Dialysis Dept, Zagreb 41001, Croatia
[15] Southmead Hosp, UK Renal Registry, Bristol, Avon, England
关键词
conservative care; dialysis; opinions; renal replacement therapy; end-stage renal disease; CHRONIC KIDNEY-DISEASE; ELDERLY-PATIENTS; PRACTICE PATTERNS; PALLIATIVE CARE; PATIENT CHOICE; STAGE; DIALYSIS; MANAGEMENT; OCTOGENARIANS; SURVIVAL;
D O I
10.1093/ndt/gft287
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
For some patients with end-stage renal disease (ESRD), providing conservative care until death may be an acceptable alternative for renal replacement therapy (RRT). We aimed to estimate the occurrence of conservative care in Europe and evaluated opinions about which factors nephrologists consider important in their decision not to offer RRT. With a web-based survey sent to nephrologists in 11 European countries, we inquired how often RRT was not started in 2009 and how specific factors would influence the nephrologists decision to provide conservative care. We compared subgroups by nephrologist and facility characteristics using chi-square tests and MannWhitney U tests. We received 433 responses. Nephrologists decided to offer conservative care in 10 of their patients [interquartile range (IQR) 520]. An additional 5 (IQR 210) of the patients chose conservative care as they refused when nephrologists intended to start RRT. Patient preference (93), severe clinical conditions (93), vascular dementia (84) and low physical functional status (75) were considered extremely or quite important in the nephrologists decision to provide conservative care. Nephrologists from countries with a low incidence of RRT, not-for-profit centres and public centres more often scored these factors as extremely or quite important than their counterparts from high-incidence countries, for-profit centres and private centres. Nephrologists estimated conservative care was provided to up to 15 of their patients in 2009. The presence of severe clinical conditions, vascular dementia and a low physical functional status are important factors in the decision-making not to start RRT. Patient preference was considered as a very important factor, confirming the importance of extensive patient education and shared decision-making.
引用
收藏
页码:2604 / 2612
页数:9
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