Must we treat noncompliant ESRD patients?

Coping with the stress induced by ESRD patient noncompliance is a time consuming, nonproductive, demoralizing undertaking that is unavoidable. An orderly, non-confrontational approach encompassing measures to protect mentally incompetent and unaware patients as well as those too sick to comprehend and consent to therapy (dialysis) is provided. Individual practitioners should utilize all available resources including patient relatives and friends, collaborating psychiatrists, and institutional risk-management officers to assist in devising the best resolution to what may escalate into an onslaught against the renal care team. No single solution is applicable to the myriad variables that may impinge on a specific patient's seemingly apathetic or hateful behavior underlying noncompliance.