We Offer Renal Replacement Therapy to Patients Who Are Not Benefitted by It.

Abstract:

:Nephrologists offer renal replacement therapy (RRT) to patients who are unlikely to benefit in part because of our discomfort discussing goals of care in the setting of an uncertain prognosis for a given individual. Permanent neurological impairment, terminal illness (life expectancy <6 months), medical conditions precluding the safe delivery of dialysis, elderly patients with poor prognosis, and those who begin "early" RRT are categories of patients for whom dialysis may not be beneficial. Successful use of time-limited trials of dialysis may reduce the number of patients who are started on RRT without significant benefit. However, clear achievable milestones and goals need to be incorporated into plans for time-limited trials to ensure that continuing RRT beyond the trial period is appropriate. The lack of information on outcomes and symptom management using a "palliative approach" to dialysis suggests this should not be a clinical option until additional study is done and efficacy data available. Clinical practice guidelines are available to assist nephrologists in the appropriate withholding of RRT.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Holley JL

doi

10.1111/sdi.12492

subject

Has Abstract

pub_date

2016-07-01 00:00:00

pages

306-8

issue

4

eissn

0894-0959

issn

1525-139X

journal_volume

29

pub_type

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