Cuidados de soporte/paliativos en diálisis. ¿ Por qué, cuándo y cómo?

One of the most important health goals in the last 40 years has been that more people with end stage renal disease (ESRD), especially elderly patients, survive because of the better access to dialysis.

Nevertheless, dialysis as renal substitution therapy of it is not risk-free. It has important limitations and morbidity and mortality for patients and it significantly affects the quality of life perceived by the patients and their families. Dialysis with high technical standards may improve the biomedical parameters of these patients, but it does not not necessarily mean that it enhances their quality of life.

In this context, the search for new models of healing, more focused on the sick person than on the treatment, has made it possible to integrate palliative medicine principles into the care of the renal patient. The main purposes of this model are conceived to provide an increase in the quality of life of the patients and to respond to the affective-emotional, social and spiritual aspects related to the disease. The inclusion of this new model would allow several problems that affect the renal patients to be addressed in a more integrated and appropriate manner: to manage pain relief and the symptoms associated with the dialysis therapy; the ethical dilemmas related to the appropriate initiation of and withdrawal from dialysis; and the support during the process of dying and mourning in the final phases of the ESRD.

Several scientific societies and organizations in nephrology around the world have adopted this model of work, promoting the integration of palliative care support into nephrology/dialysis units and nephrology fellowship training program curricula.