Régime pauvre en protéines supplémentés par les céto-analogues des acides aminés chez le patient atteint d’insuffisance rénale : pour qui ? Comment ?

Chauveau, P.; Lasseur, Catherine; Nodimar, Céline; Moreau, Karine; Trolonge, Stanislas; Aparicio, Michel; Combe, Christian

doi:10.1016/j.nephro.2018.02.014

Cited by 1 publication

(1 citation statement)

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“…Conversely, the most common diseases causing end stage kidney failure, as well as advanced chronic kidney disease, i.e., diabetes and hypertension, may be disregarded, losing an occasion for secondary prevention or at least for retarding the need for renal replacement therapy. Furthermore, leaving pre-dialysis and dialysis care out of the core studies of the country’s large university units may have critically reduced the exposure of students and trainees to fields such as peritoneal dialysis, nutritional, or pre-dialysis care of chronic kidney disease (CKD) patients, thus limiting the potential of out-of hospital care and integrated nutritional follow-up [ 32 , 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

Piccoli

Breuer

Cabiddu

et al. 2018

JCM

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Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.

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Section: Introductionmentioning

confidence: 99%