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首页> 外文期刊>Clinical kidney journal. >The use of palliative care services amongst end-stage kidney disease patients in an Irish tertiary referral centre
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The use of palliative care services amongst end-stage kidney disease patients in an Irish tertiary referral centre

机译：在爱尔兰三级转诊中心对终末期肾脏疾病患者使用姑息治疗服务

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Background Although patients with end-stage kidney disease (ESKD) have a shortened life expectancy, their end-of-life (EOL) care is suboptimal. The aim of this study was to review the utilization of specialist palliative care (SPC) in patients with ESKD in Dublin, Ireland. Methods We conducted a retrospective chart review of prevalent patients with ESKD who died between January 2005 and December 2009 at a tertiary referral centre. We recorded SPC referrals, modality of renal replacement therapy, age and place of death. Results Of 131 included patients, 88 (67.2%) were male, mean age at death was 63.2 ± 15.1 years and 102 (77.9%) were treated with haemodialysis. Forty-eight patients (36.7%) were referred to SPC, who were involved in the patients' management for a median of 12 days (range 0–907) before death. A total 104 patients (79.4%) died in an acute hospital, 19 (14.5%) died at home, 3 (2.3%) died in an inpatient hospice and the place of death was unknown for 5 patients (3.8%). Dialysis was withdrawn prior to death in 50 patients (38.1%), with a median time to death after withdrawal of dialysis of 6 days (0–105 days). A discussion regarding the withdrawal of dialysis was more frequently held with family member(s) rather than the patient. Conclusions SPC was involved in the antemortem care of ～1/3 of the patients with the majority of referrals placed at a late stage. Given the short timeframe until death once dialysis is withdrawn, it is imperative that appropriate EOL care is instituted. This study identifies an underutilization of SPC and improved integration of palliative care and nephrology services may optimize EOL care for patients with ESKD.
机译：背景技术尽管患有终末期肾脏疾病（ESKD）的患者的预期寿命较短，但他们的临终（EOL）护理并不理想。这项研究的目的是回顾爱尔兰都柏林的ESKD患者使用专业姑息治疗（SPC）的情况。方法我们对2005年1月至2009年12月之间在三级转诊中心死亡的ESKD流行患者进行了回顾性图表回顾。我们记录了SPC转诊，肾脏替代治疗的方式，年龄和死亡地点。结果131例患者中，男性88例（67.2％），平均死亡年龄为63.2±15.1岁，接受血液透析治疗的患者102例（77.9％）。四十八名患者（36.7％）被转诊至SPC，他们在死亡前参与患者管理的中位时间为12天（范围0-907）。总共104例患者（79.4％）在一家急诊医院死亡，19例（14.5％）在家中死亡，3例（2.3％）在住院的临终关怀中死亡，5例患者（3.8％）的死亡地点未知。 50例患者在死亡前退出了透析治疗（38.1％），而中止透析后的中位死亡时间为6天（0–105天）。关于撤回透析的讨论更多地是由家庭成员而不是患者进行。结论SPC参与了〜1/3的患者的死前护理，大多数转诊处于晚期。由于到透析结束后直至死亡的时间很短，因此必须建立适当的EOL护理。这项研究发现SPC的利用不足，姑息治疗和肾病学服务的改善集成可以优化ESKD患者的EOL护理。

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