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首页> 外文期刊>Italian Journal of Medicine >Decision-making in the implementation or withdrawal of dialysis in the old complex patient
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Decision-making in the implementation or withdrawal of dialysis in the old complex patient

机译：在旧复杂患者中的实施或撤离透析的决策

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In the last years the population of patients with end-stage renal disease has been growing and the number of patients over 74 years old on renal replacement therapy is rising. However, an increasing number of studies have shown that dialysis is not always associated with a longer life expectancy and a better quality of life for elderly patients with severe chronic comorbidity. Moreover, in selected patients conservative therapy provides a survival and quality of life comparable or even superior to that offered by dialysis. These situations pose new ethical and clinical issues. Nephrologists are increasingly faced with difficult decisions about the optimal therapeutic strategies and what is in the best interest of each patient. The new edition of the Renal Physician Association’s guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis takes into account these changes. For this reason the guideline advocates the use of specific parameters and tools for the prognosis assessment in order to identify the classes of patients with very poor prognosis. The importance of discussing the diagnosis, prognosis and treatment options with the patient is emphasized. Shared decision-making is the model for the physician-patient relationship. Treatment options include renal replacement therapy, not starting or stopping dialysis, and continuing medical management or palliative care. Palliative care should be offered to all patients with end-stage renal disease, whether they start or refuse dialysis and whether they continue or withdraw from dialysis. Furthermore, palliative care should be provided throughout the course of the disease, not only at the end of life.
机译：在过去几年中，肾病患者的患者患者越来越多，肾脏替代疗法74岁以上的患者的数量正在上升。然而，越来越多的研究表明，透析并不总是与较长的寿命和更好的严重慢性合并症患者的寿命和更好的生活质量相关。此外，在选定的患者中，保守疗法提供了透析提供的甚至优于透析的生存和质量。这些情况构成了新的道德和临床问题。肾病学家越来越多地面临着最佳治疗策略的难度决定，以及每个患者的最佳利益。新版肾脏医师协会在适当启动和撤离透析中撤离的共享决策指南考虑到这些变更。因此，指南倡导使用特定参数和工具进行预后评估，以确定预后差的患者的患者。强调讨论患者诊断，预后和治疗方案的重要性。共享决策是医生患者关系的模型。治疗方案包括肾脏替代疗法，未开始或停止透析，继续进行医疗管理或姑息治疗。姑息治疗应向所有患有终末期肾病的患者提供，无论是开始还是拒绝透析，是否继续或退出透析。此外，应在整个疾病过程中提供姑息治疗，不仅在生命结束时。

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