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

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. N...

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Autores principales: Piccoli, Giorgina Barbara, Breuer, Conrad, Cabiddu, Gianfranca, Testa, Angelo, Jadeau, Christelle, Brunori, Giuliano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111293/
https://www.ncbi.nlm.nih.gov/pubmed/30081442
http://dx.doi.org/10.3390/jcm7080199
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author Piccoli, Giorgina Barbara
Breuer, Conrad
Cabiddu, Gianfranca
Testa, Angelo
Jadeau, Christelle
Brunori, Giuliano
author_facet Piccoli, Giorgina Barbara
Breuer, Conrad
Cabiddu, Gianfranca
Testa, Angelo
Jadeau, Christelle
Brunori, Giuliano
author_sort Piccoli, Giorgina Barbara
collection PubMed
description 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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spelling pubmed-61112932018-08-28 Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline Piccoli, Giorgina Barbara Breuer, Conrad Cabiddu, Gianfranca Testa, Angelo Jadeau, Christelle Brunori, Giuliano J Clin Med Concept Paper 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. MDPI 2018-08-03 /pmc/articles/PMC6111293/ /pubmed/30081442 http://dx.doi.org/10.3390/jcm7080199 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Concept Paper
Piccoli, Giorgina Barbara
Breuer, Conrad
Cabiddu, Gianfranca
Testa, Angelo
Jadeau, Christelle
Brunori, Giuliano
Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title_full Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title_fullStr Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title_full_unstemmed Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title_short Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline
title_sort where are you going, nephrology? considerations on models of care in an evolving discipline
topic Concept Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111293/
https://www.ncbi.nlm.nih.gov/pubmed/30081442
http://dx.doi.org/10.3390/jcm7080199
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