保住腎功能，延緩洗腎時機

Protect Kidney Function, Delay the Time of Entering Dialysis

台灣洗腎病患盛行率與每年新增加洗腎發生率都是世界第一，「洗腎王國」的污名揮之不去，且近年來健保署醫療費用支出的疾病排名中，慢性腎衰竭亦持續位居第1名，而其患者有超過4成是糖尿病造成的。因此平時作好血壓、血糖、血脂的控管極為重要，再者如不幸罹患有慢性腎衰竭疾病，經由適當的醫療照護可以有效地保護我們的腎臟功能，可延緩進入洗腎（透析）治療的時間，進而撙節醫療資源的耗用，維持病人的社會功能與生活品質。最後，如進入到必需洗腎（透析）的階段，藉由醫病共享決策（Shared Decision Making, SDM），由病人、家屬與醫院的照護團隊討論後，病人可依自己的作息需求，選擇適合的透析方式，使得病人更放心地接受治療，有助於改善其焦慮程度，並促進良好醫病關係與提升醫囑遵從度。再者，透析治療過程中，親友的支持可幫助病人減少心理上的不安全感，同時維持良好的人際關係。 Taiwan has the highest incidence and prevalence rates of end-stage renal disease (ESRD) in the world, so that we can't get rid of the stigma of the ＂dialysis kingdom＂. According to the recent expenditure data of Taiwan National Health Insurance Administration, the government tends to spend most on chronic kidney disease (CKD), of which diabetes mellitus accounts for more than 40%. Therefore, optimal control of blood pressure, blood sugar and lipids is extremely important and imperative. If patients were suffering from progressive CKD, they can still effectively protect their kidney function through multidisciplinary team care, delay the time of entering dialysis, and eventually save the consumption of medical resources. Additionally, this integrated medical care program benefits CKD patients to maintain their social function and quality of life. Furthermore, when chronic kidney disease progresses to ESRD, the CKD patients can choose the most appropriate treatment through the Shared Decision Making (SDM), where medical care team group, patients and their families share the best available evidence and where patients are supported to consider options based on their lifestyles, and to achieve informed preferences. This will also help patients to reduce their anxiety, to improve medical compliance and to promote good doctor-patient relationship. Finally, the support of relatives and friends during dialysis treatment can help patients reduce their psychological insecurity and maintain their good relationships.

Taiwan has the highest incidence and prevalence rates of end-stage renal disease (ESRD) in the world, so that we can't get rid of the stigma of the ＂dialysis kingdom＂. According to the recent expenditure data of Taiwan National Health Insurance Administration, the government tends to spend most on chronic kidney disease (CKD), of which diabetes mellitus accounts for more than 40%. Therefore, optimal control of blood pressure, blood sugar and lipids is extremely important and imperative. If patients were suffering from progressive CKD, they can still effectively protect their kidney function through multidisciplinary team care, delay the time of entering dialysis, and eventually save the consumption of medical resources. Additionally, this integrated medical care program benefits CKD patients to maintain their social function and quality of life. Furthermore, when chronic kidney disease progresses to ESRD, the CKD patients can choose the most appropriate treatment through the Shared Decision Making (SDM), where medical care team group, patients and their families share the best available evidence and where patients are supported to consider options based on their lifestyles, and to achieve informed preferences. This will also help patients to reduce their anxiety, to improve medical compliance and to promote good doctor-patient relationship. Finally, the support of relatives and friends during dialysis treatment can help patients reduce their psychological insecurity and maintain their good relationships.