血液透析病人選擇腎臟病支持療護的決策

Decisions to Choose Palliative Care for Patients Under Chronic Hemodialysis

趙家德(Chia-Ter Chao) ； 蔡宏斌(Hung-Bin Tsai) ； 程劭儀(Shao-Yi Cheng)

《腎臟與透析》 34卷1期 (2022/03) Pp. 18-25

https://doi.org/10.6340/KD.202203_34(1).0004

摘要

臺灣末期腎病的發生率及盛行率均高，其中90%病人接受血液透析（血透）。這群病人除了不良預後的機率較高以外，症狀負擔也較大。在特定血透病人，開始或持續慢性透析治療對他們並無法提供明顯存活助益，反而會讓其生活功能逐漸衰退．在這群病人，建議可以考慮尊重他們的主觀意願，提供合適的腎臟病支持療護。在本篇綜述，我們將提供對於血透病人腎臟病支持療護或撤除透析的適應症及做法，希望可以讓讀者瞭解此一議題。

關鍵字

腎臟病支持療護 ； 生命末期腎臟病人 ； 新冠肺炎重症 ； 限時透析醫療嘗試 ； 血液透析

並列摘要

In Taiwan, the incidence and prevalence of end-stage renal disease (ESRD) are high, and among those with ESRD in Taiwan, 90% receive chronic hemodialysis. Taiwanese ESRD patients under chronic hemodialysis also have a tremendous symptom burden. In a subgroup of ESRD patients under chronic hemodialysis, initiating or continuing dialysis may not improve their survival but further aggravate their functional status and impair their performance. It is likely that the provision of kidney supportive care or palliative care in this subgroup of patients suits these patients more. In this review, we will provide a domestic perspective regarding the indication and implementation details of kidney supportive care and also compare this information to that from other countries.

並列關鍵字

hemodialysis ； kidney supportive care ； end-of-life renal patients ； critically ill COVID-19 patients ； time-limited trial of dialysis