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Renal supportive care (RSC) denotes a care program dedicated for patients with acute, chronic renal failure, and end-stage renal disease (ESRD), aiming to offer maximal symptom relief and optimize patients' quality of life. The uncertainty of prognosis for patients with chronic kidney disease and ESRD, the sociocultural issues inherent to the Taiwanese society, and the void of structured and practical RSC pathway, contributes to the underrecognition and poor utilization of RSC. Taiwanese patients rarely receive information regarding RSC as part of a standardized care and are not commonly offered this option. In National Taiwan University Hospital Jinshan branch, we started a RSC subprogram, supported by the community-based palliative/hospice care main program. We focused on understanding the need and providing the choice of RSC to suitable candidates. A three-step and four-phase protocol was designed and implemented to identify appropriate patients and to enhance the applicability of the RSC. We harnessed family visit and home-based family meeting as a vehicle to understand the patients' preferences, to discover what ESRD patients and their family value most, and to introduce the option of RSC. In the current review, we described our pilot experience of establishing a RSC program in Taiwan, and discuss its potential advantage.

Background/PurposeSeveral studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD.MethodsA single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)

Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries.

Wang et al 1 reported in the Journal of the Formosan Medical Association the prevalence rate of methicillinresistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis (HD) patients in Taiwan was 5.9%, which was nearly one-half of those reported by Lederer et al. 2 from Germany. However, the methods of detecting MRSA carriage were different in these two studies: the former used one single nasal swab culture, while the later used at least two (varied between two and 10) nasal swab screenings. It is inappropriate to compare a prevalence rate by using different detecting strategies. Our previous report detected MRSA carriers by performing two consecutive nasal swab cultures obtained at a 1-week interval in another tertiary medical center in northern Taiwan. 3 Those who had at least one positive culture of MRSA were defined as MRSA carriers. We found the prevalence of MRSA nasal carriage in HD patients was 9.48%. In detail, there were 13 (4.25%) persistent carriers and 16 (5.23%) intermittent carriers. Following this paper, serial annual surveillance of MRSA nasal carriage in our HD patients still identified these two patterns of MRSA carriers (Table 1). Using only one examination may fail to identify a significant portion of MRSA carriers. Similar findings were also shown in other studies to detect S. aureus carriership. 4,5 Therefore, we suggest screening of MRSA nasal carriage in HD patients should be carried out by at least two consecutive weekly nasal swab cultures in order to maximize the probability of identifying all MRSA carriers.