# New Paradigms in Nephrology Nursing

## TL;DR

The paper discusses the need for a shift in nephrology nursing in Portugal to better address palliative care for elderly CKD patients and conditions like cardiorenal syndrome.

## Contribution

The paper introduces a new nursing consultation model focused on conservative treatment and palliative care for fragile CKD patients.

## Key findings

- Conservative treatment is a valid alternative to dialysis for frail CKD patients.
- Palliative care should be integrated into healthcare for chronic and advanced conditions.
- A nursing consultation model was implemented to provide personalized monitoring and care.

## Abstract

With the aging of the population and better healthcare, more elderly and frail patients are reaching the terminal stage of chronic kidney disease (CKD). In Portugal, one of the European leaders in the incidence of renal function replacement therapy, hemodialysis and peritoneal dialysis continue to be the focus of treatment, even in patients with multiple comorbidities, low functional reserve, and care dependency. However, several studies have revealed that these therapies in fragile patients do not provide quality of life or a greater survival rate but are associated with increased suffering due to the loss of functional capacity, with a subsequent need to abandon dialysis.

Nephrology nursing in Portugal has always followed this more technical aspect necessary for dialysis. However, it has not dedicated itself to conservative treatment or other nephrology areas requiring differentiated palliative care, such as cardiorenal syndrome (CRS). Conservative treatment is a valid alternative that corresponds to the continuation of comprehensive therapy for patients with CKD without resorting to dialysis techniques. It seeks to prevent the deterioration of residual renal function while alleviating symptoms and complications resulting from disease progression, with personalized palliative care support aimed at optimizing the physical, emotional, and spiritual well-being of the patient and their family.

On the other hand, despite being palliative, patients with CRS can benefit from more invasive techniques such as assisted peritoneal ultrafiltration to control symptoms, along with an educational approach that promotes their empowerment. This need for a paradigm shift led us to implement a specific nursing consultation for conservative treatment and CRS, ensuring personalized monitoring of these illnesses. Palliative care must be an integral part of healthcare, not only for incurable and terminal diseases but also for chronic, advanced, and evolving conditions.