Planning ESKD treatment: a plea for a stepwise person-centered approach including conservative care
A paradigm shift in the treatment of end-stage kidney disease (ESKD) is urgently needed. New ESKD policies should include integrated and person-centered care that focuses on the individual's preferences, needs, and values for health care. Based on the example of Portugal, a country with a very high number of prevalent in-center hemodialysis patients, the authors reflect on the past and present of ESKD treatment worldwide, trying to summarize the conceptual changes in the efficiency and equity of ESKD treatment. An optimal approach in ESKD management should consider all options for renal replacement therapy, including a comprehensive conservative approach, of which the incidence and prevalence should be reported on a regular basis for each country and for Europe. An active holistic care to patients with ESKD suffering from severe illness or near the end of life, without dialysis or kidney transplant, is still frequently ignored as an option. In cases of frail or very old individuals or in those with multiple co-morbidities or in poor physical condition, conservative treatment should be considered as a firstline option. A proposal of ESKD treatment following the model of classification of CKD is presented. Up-to-date regulations from national health authorities are needed, especially on the priority policy of supportive/palliative care in non-malignant disease, including ESKD.
| Main Authors: | , |
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| Format: | Digital revista |
| Language: | English |
| Published: |
Sociedade Portuguesa de Nefrologia
2019
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| Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692019000300002 |
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