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Withdrawal from dialysis: a palliative care perspective.
S Chater1, S N Davison, M J Germain
1Edinburgh Cancer Center, Western General Hospital, Edinburgh, Scotland, UK. schater@doctors.org.uk
Clinical Nephrology
|December 5, 2006
Summary
Palliative care significantly improved symptom management for patients withdrawing from dialysis, reducing pain, agitation, and dyspnea. This pilot study highlights palliative medicine
Area of Science:
- Nephrology
- Palliative Care
- Geriatrics
Background:
- Dialysis withdrawal is a complex decision for patients with end-stage renal disease (ESRD).
- Symptom burden and psychological distress are common concerns during this transition.
- The role of palliative care in managing symptoms at dialysis withdrawal requires further investigation.
Purpose of the Study:
- To evaluate the impact of a palliative care team on symptom management in patients withdrawing from dialysis.
- To describe survival time, symptom prevalence, and the nature of death in this patient population.
Main Methods:
- Retrospective chart review of 35 patients who withdrew from dialysis and received palliative care.
- Data collected included ESRD etiology, comorbidities, dialysis details, survival, withdrawal reasons, competency, symptoms, and death characteristics.
- Symptom prevalence was analyzed before and after palliative care intervention.
Main Results:
- Mean survival time post-withdrawal was 10 days.
- Frequent symptoms included confusion, agitation, pain, and dyspnea; 1/3 had cognitive impairment at withdrawal.
- Palliative care reduced symptom prevalence: pain (53% to 20%), agitation (68% to 33%), dyspnea (46% to 26%).
Conclusions:
- Palliative care significantly alleviates symptoms in patients discontinuing dialysis.
- Opioids and benzodiazepines were crucial in managing symptoms in over 90% of patients.
- Palliative medicine offers substantial potential to enhance end-of-life care for dialysis patients.
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