关键词: 维持性血液透析, 临终关怀, 姑息治疗

Abstract: Objective This retrospective and observational study was carried out to analyze the incidence of dialysis discontinuation and the related palliative care in maintenance hemodialysis (MHD) patients. Methods We retrospectively evaluated the patients who died in Pu-Xi Dialysis Unit of Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China from Jan. 1, 1998 to Dec. 31, 2012. Their sex, age, dialysis age, and primary disease were compared between dialysis discontinuation group and non-discontinuation group. We also collected the information about cause of death and related palliative care. Results A total of 115 MHD patients (male 69 and female 46; mean age 64.6±14.2 years old; mean dialysis age 5.4 years) who died in this period were analyzed. The major causes of renal failure were chronic glomerulonephritis (27.8%), hypertensive nephrosclerosis (23.5%), and diabetic nephropathy (12.2%). The most common cause of death was cerebrovascular accident (39.1%), followed by sepsis (15.7%), cardiocerebral events (10.4%), sudden death (8.7%), and advanced cancers (8.7%). Of the 9 patients (8%) discounting dialysis, 2 were females and 7 were males, and the median living interval after dialysis discontinuation was only 8.1 days. The causes of dialysis continuation included advanced cancers (4 cases), severe infection (one case), cerebral accident (one case), technical difficulties in dialysis (one case), and financial problems (2 cases). Support measures were given to all of the 9 patients after dialysis discontinuation. Conclusions Dialysis registration system is useful for the analysis of patients discounting dialysis. In this series of patients, 8% patients discontinued their dialysis, much lower than the ratio in developed countries. The major cause of death in the patients discounting dialysis was advanced cancers.

Key words: Maintenance hemodialysis, Hospice care, Palliative therapy