Maximal conservative management

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• 作者：David S. Game ; Edwina A. Brown
• 关键词：conservative management ; dialysis ; palliative care ; quality of life ; renal failure ; survival
• 刊名：Medicine
• 出版年：2007
• 出版时间：August 2007
• 年：2007
• 卷：35
• 期：8
• 页码：470-472
• 全文大小：107 K

文摘

The aim of renal replacement therapy (RRT) is to prolong the quantity of life without diminishing the quality of remaining years. Unfortunately, in some patients, this is far from reality. Maximal conservative management is the support of patients with end-stage renal failure (ESRF) without resorting to RRT. This support addresses the patient’s physical, emotional and spiritual needs until the end of life: a multi-disciplinary approach is, therefore, essential. In the UK, there are wide disparities in the provision of maximal conservative and palliative care for patients with ESRF, but this is improving. Medical therapy includes the treatment of underlying renal pathology and other manoeuvres to prolong residual renal function such as anti-hypertensive medication. As renal function declines, the treatment of renal anaemia with erythropoietin and optimization of fluid balance with diuretics can become more important. Pain control must be achieved but can be problematic in ESRF because of decreased elimination of drugs and their metabolites: various strategies are discussed. There are some data to suggest that selected patients with high comorbidity live just as long with maximal conservative management as if they had dialysis. However, to withhold RRT from all patients with multiple comorbidity would be ethically questionable and would deny some patients the chance of a longer, happier life. The aim of this article is to address some of the anxieties experienced by both the clinician and the patient when opting for maximal conservative management in ESRF.