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Dialysis discontinuation: quo vadis?
Fliss Murtagh1, Lewis M Cohen, Michael J Germain
1Department of Palliative Care, Policy and Rehabilitation, King's College London, Weston Education Centre, London, United Kingdom.
Advances in Chronic Kidney Disease
|October 2, 2007
Summary
Dialysis discontinuation is a common cause of death for patients with chronic kidney disease. Research suggests a need for patient-centered palliative care approaches to manage treatment termination.
Area of Science:
- Nephrology
- Palliative Medicine
- Medical Ethics
Background:
- Dialysis discontinuation precedes approximately 25% of deaths among patients on dialysis in the United States.
- Once viewed as suicide, treatment termination is now a recognized and increasingly common end-of-life decision globally.
- The aging and deteriorating health of the chronic kidney disease population suggests rising rates of dialysis discontinuation.
Purpose of the Study:
- To review and critique existing literature on dialysis discontinuation, primarily from the US, UK, and Canada.
- To assess the relevance of current research findings to clinical practice.
- To identify future research needs and practice improvements.
Main Methods:
- Systematic review and critical analysis of published literature on dialysis discontinuation.
- Examination of studies focusing on patient demographics, decision-making processes, and outcomes.
- Synthesis of findings to inform clinical practice and future research directions.
Main Results:
- Dialysis discontinuation is a significant factor in mortality for end-stage renal disease patients.
- The practice is increasingly accepted, reflecting a shift in medical and ethical perspectives.
- Existing literature provides a foundation but highlights gaps in understanding practice variability.
Conclusions:
- Dialysis discontinuation is a complex issue requiring careful consideration within the context of chronic kidney disease management.
- There is a critical need for further research into practice variations and the implementation of patient-centered care.
- Integrating modern palliative medicine principles is essential for supporting patients considering treatment termination.
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