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Том 22 №2 2020 год - Нефрология и диализ

Начало диализа, выбор метода, доступ и программы лечения: итоги конференции KDIGO (Инициатива по улучшению глобальных исходов заболеваний почек) по спорным вопросам


Т. Чан Кристофер Бланкестин Петер Дж. Дембер Лаура М. Галлиени Маурицио Харрис Дэвид Ч.Х. Лок Шармэн Э. Меторта Ражниш Стивенс Пауль Э. Ванг Анжела Й-М. Чонг Майкл Велер Дэвид К. Винкельмаейр Вольфганг К. Поллок Кэрол А.

DOI: 10.28996/2618-9801-2020-2-152-167

Аннотация: Во всем мире растет число пациентов, получающих постоянное поддерживающее лечение диализом, однако существует значительная вариабельность в практических подходах к его началу. Такие факторы, как доступность ресурсов, причины начала диализа, время его начала, обучение и подготовка пациентов, метод диализа и диализный доступ, а также варьирующие в зависимости от страны специфические факторы значительно влияют на восприятие пациентов и на результаты лечения. По всему миру возросло число пациентов с терминальной стадией болезни почек (ТСБП), в связи с этим все более широко признается важность участия пациента в определении целей медицинской помощи и в принятии решений в отношении лечения. В январе 2018 года была созвана конференция KDIGO (Инициатива по улучшению глобальных исходов заболеваний почек), посвященная спорным вопросам, касающимся начала диализа, в том числе выбору метода лечения, доступу и программам лечения. Здесь представлено краткое содержание дискуссий на конференции, в том числе относительно выявленных пробелов в знаниях, спорных вопросов и приоритетов дальнейших исследований. Одной из новейших главных тем, представленных на конференции, стала необходимость отказаться от унифицированного подхода к диализу в пользу более индивидуального подхода, который включает в себя цели и предпочтения пациента, учитывая при этом наилучшую медицинскую практику, ориентированную на качество лечения и безопасность пациента. Определение и включение ориентированных на пациентов целей, которые могут быть приняты как показатели качества в контексте различных систем здравоохранения для достижения относительного равновесия результатов, потребует согласованности целей и побуждений при взаимодействии между пациентами, поставщиками услуг, регуляторными органами и плательщиками. Степень такой согласованности будет варьировать в зависимости от системы здравоохранения конкретной страны.

Весь текст

Ключевые слова: целенаправленный диализ, гемодиализ, домашний диализ, начало, метод, перитонеальный диализ, программа лечения, контроль симптомов, сосудистый и перитонеальный диализный доступ, goal-directed dialysis, hemodialysis, home dialysis, initiation, modality, peritoneal dialysis, prescription, symptom control, vascular and peritoneal dialysis access

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