Patient-centred approaches for the management of unpleasant symptoms in kidney disease

医学 头昏眼花 恶心 肌肉痉挛 腹痛 呕吐 生活质量(医疗保健) 重症监护医学 焦虑 肾脏疾病 便秘 透析 疾病 内科学 精神科 护理部
作者
Kamyar Kalantar‐Zadeh,Mark B. Lockwood,Connie M. Rhee,Ekamol Tantisattamo,Sharon Andreoli,Alessandro Balducci,Paul Laffin,Tess Harris,Richard Knight,Latha Kumaraswami,Vassilios Liakopoulos,Siu‐Fai Lui,Sajay Kumar,Maggie Ng,Gamal Saadi,Ifeoma Ulasi,Allison Tong,Philip Kam‐Tao Li
出处
期刊:Nature Reviews Nephrology [Nature Portfolio]
卷期号:18 (3): 185-198 被引量:137
标识
DOI:10.1038/s41581-021-00518-z
摘要

Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. Such an approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation. Unpleasant symptoms — arising as a consequence of disease processes, comorbid conditions, therapeutics and lifestyle regimens — adversely affect the quality of life and life participation of patients with chronic kidney disease (CKD). This Perspective examines the concept and scope of symptom burden in CKD, theoretical frameworks and validated tools for symptom appraisal, and strategies with which to support patients actively through the identification and targeting of unpleasant symptoms.
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