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Reflections on end-of-life dialysis
1Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.
Jornal Brasileiro De Nefrologia
|May 22, 2018
Summary
As the global population ages, more patients with chronic kidney disease require dialysis. This study provides a framework for ethically discussing dialysis withdrawal in end-of-life care.
Area of Science:
- Nephrology
- Geriatrics
- Palliative Care
Background:
- Global population aging and increased prevalence of chronic kidney disease (CKD).
- Rising incidence of diabetes mellitus and systemic arterial hypertension contributing to CKD.
- Increased number of patients requiring dialysis due to expanded healthcare services and improved survival rates.
Purpose of the Study:
- To discuss the complexities of dialysis in the final phase of life.
- To present a systematic approach for addressing the dilemma of initiating, maintaining, or discontinuing dialysis.
- To guide multidisciplinary teams in ethically and humanely approaching patients and families regarding dialysis decisions.
Main Methods:
- Systematic review and ethical analysis of dialysis in end-of-life care.
- Discussion of patient-centered evaluation considering quality of life and comorbidities.
- Framework for multidisciplinary team communication and decision-making.
Main Results:
- Dialysis, while maintaining physiological balance, does not always improve quality of life for elderly patients with comorbidities.
- Partial recovery is common despite significant social and financial costs of dialysis.
- Individualized assessment is crucial for decisions regarding dialysis initiation, continuation, or discontinuation.
Conclusions:
- Ethical and humanitarian considerations are paramount when discussing dialysis in end-of-life scenarios.
- A structured approach is needed to support patients, families, and healthcare providers in complex end-of-life dialysis decisions.
- The multidisciplinary team must be equipped to navigate these sensitive discussions.
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