Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

被引:90
作者
Murtagh, Fliss E. M. [1 ]
Burns, Aine [2 ]
Moranne, Olivier [3 ,4 ]
Morton, Rachael L. [5 ]
Naicker, Saraladevi [6 ]
机构
[1] Kings Coll London, Cicely Saunders Inst, Dept Palliat Care Policy & Rehabil, London, England
[2] Royal Free Hosp, Natl Hlth Serv Fdn Trust, Dept Nephrol, London, England
[3] Univ Montpellier, Fac Med, Inst Univ Rech Clin, Epidemiol Biostat & Sante Publ,EA2415, Montpellier, France
[4] Ctr Hosp Univ Nimes, Nephrol & Dialysis Dept, Nimes, France
[5] Univ Sydney, Natl Hlth & Med Res Ctr, Clin Trials Ctr, Sydney, NSW, Australia
[6] Univ Witwatersrand, Sch Clin Med, Dept Internal Med, Johannesburg, South Africa
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2016年 / 11卷 / 10期
关键词
QUALITY-OF-LIFE; RENAL REPLACEMENT THERAPY; ELDERLY-PATIENTS; DECISION-MAKING; PALLIATIVE CARE; DIALYSIS; SURVIVAL; MANAGEMENT; FAILURE; SYMPTOMS;
D O I
10.2215/CJN.04840516
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care.
引用
收藏
页码:1909 / 1914
页数:6
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