Is there a role for hydration at the end of life?

To review current evidence on issues central to the hydration debate.

Worldwide, there are wide variations in hydration practice in terminally ill patients, reflecting divergent beliefs of medical providers, and the paucity in scientific evidence. This issue is particularly distressful to patients/families and nurses, yet their involvement in clinical decision-making remains insufficient. A short preliminary randomized controlled intervention trial (in advanced cancer patients) adds to the mounting evidence in support of hydration in improving neuro-cognitive symptoms associated with fluid deficits. On the other hand, majority of trials conducted in patients at the very end of life (survival days or weeks), while confirming high symptom burden, suggest no relationship to fluid status, or no significant benefit with hydration intervention. In Japan, the development of national clinical guidelines for hydration therapy in terminally ill cancer patients is a significant step forward, and brings attention to this important issue.

Areas of future research should include patients at various stages of the illness trajectory and involve noncancer illnesses. Appropriately powered, randomized, double-blind studies of hydration are awaited. Till then, the recommendation is to individualize hydration decisions and include participation of patient/families and other disciplines.