干货,2015肾内科年度会资料2.pdfVIP

中华医学会肾脏病学分会2015年学术年会 大会报告 Chronic Kidney Disease: current state of art and science Adeera Levin Canada 1 中华医学会肾脏病学分会2015年学术年会 大会报告 Conservative therapy for ESKD David Harris Australia The rising tide of elderly patients with ESKD is driving a new focus on conservative management of ESKD and its symptoms. The principal aims of conservative therapy include the avoidance of dialysis in those for whom it would provide no benefit or may do harm, and to provide adequate symptom control. Whereas survival overall is worse with conservative therapy for ESKD than it is with dialysis, for certain groups, especially elderly patients and those with high co-morbidity, conservative therapy is as effective as dialysis in prolonging survival. Moreover, observed differences in survival time between dialytic and conservative therapy may disappear when dialysis days are excluded. Symptom control appears to be little different between conservative and dialytic therapy. Pain can be adequately managed using a hierarchical approach and avoiding certain analgesics. Gabapentin is effective for control of pain, pruritus and restless legs but side effects may be greater in those receiving non-dialytic therapy. Ideal conservative care requires a coordinated, multi-professional team approach. ESKD的保守治疗 高龄患者发生ESKD 的趋势日益凸显，这促使新的焦点聚集在ESKD 的保守及对症治疗。保守 治疗的基本原则包括对于透析有害无利的患者避免透析以及充分地控制患者的尿毒症症状。 尽管ESKD 保守治疗的总生存率不如透析治疗，然而对于某些人群，尤其是高龄及严重合并症 患者，保守治疗像