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Dying on dialysis: the case for a dignified withdrawal
Rebecca J Schmidt1, Alvin H Moss
1Sections of Nephrology and, †Supportive Care, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.
Clinical Journal of the American Society of Nephrology : CJASN
|August 24, 2013
Summary
Patients on long-term hemodialysis may experience subtle decline, prompting a review of dialysis benefits versus burdens. This approach supports patient-centered decisions regarding dialysis withdrawal for improved quality of life.
Area of Science:
- Nephrology
- Geriatrics
- Palliative Care
Background:
- Long-term maintenance hemodialysis can lead to subtle clinical deterioration, impacting patient quality of life.
- This decline presents medical, ethical, and emotional challenges for patients, families, and nephrologists.
Observation:
- A significant decline in clinical status necessitates re-evaluating the benefits versus burdens of ongoing dialysis.
- Patient-centered care is crucial, focusing on individual quality of life rather than solely disease progression.
Findings:
- This paper outlines a rationale and objective approach for initiating and managing dialysis withdrawal.
- It addresses patients desiring withdrawal due to poor quality of life and those for whom withdrawal is medically appropriate.
Implications:
- Facilitates informed decision-making regarding dialysis withdrawal, respecting patient autonomy and quality of life.
- Provides a framework for managing complex ethical and clinical situations in end-stage renal disease care.
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