With a rapidly aging population of patients with end-stage kidney disease (ESKD) starting dialysis, the demands on caregivers have increased. The need for help with activities of daily living (bathing, dressing), mobility, transportation, social support and food preparation are often not anticipated. The burden of these additional roles and lack of support can have a major negative impact on the caregivers physical, social and emotional health.

In a recentBMC肾脏publication,Shah et al.与接受透析或保守护理（仅限医疗管理）的老年人（> 75岁）的照顾者的健康相关生活质量和生活质量。护理人员完成了调查，这些调查评估了他们的健康生活质量和经验，因为护理人员这些调查解决了医疗保健团队常常忘记的区域，例如外面护理，社会支持，机构支持，控制关怀和关系的活动他关心收件人。利用这项调查强调了护理人员生活中的变化，这些生活通常不考虑在患者和家庭的结束阶段肾病管理中的咨询。While there was no difference in the HRQoL, the caregivers of dialysis patients reported a worse carer experience, where the survey results of this group reflected the perception of providing an ‘intense’ level of care to recipients in bad health and for more than 20 hours/weeks. This is especially striking considering 70% of the caregivers surveyed had been providing this level of care for >2 years. These findings highlight the need to expand the dialysis preparations and the support provided to caregivers.

目前，协议专注于关于透析模型选项的教育，透析的早期推荐，用于诊断程序的患者的诊断计划/创作和信息。Most of the data已经帮助塑造目前的方法是基于结果，例如患者出现患者的住院，发病率，死亡率，营养状况或感染率，几乎没有准备或未制备。虽然这些是解决的重要问题，但这种方法并不考虑透析对患者生命的整体影响或对护理人员的影响，包括改变他们的生活方式，就业和家庭责任。因此，许多护理人员与如何在没有技能和资源的情况下满足家庭成员的需求。

caregivers can experience stress, depression, feelings of being overwhelmed and social isolation.

随着越来越多的老年人需要透析支持，它们将具有更高的可能性，因此它们将具有较高的可能性，从而潜在地对护理的帮助。因此，护理人员可以体验压力，抑郁，被淹没和社会隔离的感受。注意到了对护理人员的影响another studyof 100 hemodialysis patients and their primary caregivers utilizing the Short-Form Health Survey (SF-36). After more than 4 months of dialysis, caregivers were reported to have higher subjective burden scores. Current practices do not encompass follow-up with the caregivers to see how they are adjusting to the initiation of dialysis and how they are dealing with the transition. Asystematic reviewof studies with interventions for informal caregivers demonstrated only three studies with interventions for caregivers and these involved education material to enhance caregiver knowledge.

Our approach to dialysis preparation falls short if providers are not first acknowledging with patients and their caregivers the impact of end-stage kidney disease on their lives and providing the resources and support they need during this transition period. Understanding what is important to them and what they do on a day-to-day basis in terms of work, family, and social obligations needs to be part of routine discussions. Discussions about the impact on the family and caregivers also needs to be part of the routine dialysis preparations.