Maximal conservative management

• Autores: Edwina A. Brown
• Localización: Medicine, ISSN-e 1357-3039, Vol. 43, Nº. 8, 2016, págs. 493-495
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • 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 kidney disease (ESKD) without resorting to RRT. This support addresses the patient's physical, emotional and spiritual needs until the end of life: a multidisciplinary approach is therefore essential. 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 ESKD because of decreased elimination of drugs and their metabolites: various strategies are discussed. There are some data to suggest that selected patients with high co-morbidity live just as long with maximal conservative management as if they had dialysis. However, to withhold RRT from all patients with multiple co-morbidities would be ethically questionable. The decision to opt for non-dialysis medical therapy or conservative care should be made only after shared decision making between the patient, their families and the healthcare team.