http://www.ncbi.nlm.nih.gov/pubmed/23586687

Nephrology (Carlton). 2013 Apr 16. doi: 10.1111/nep.12065. [Epub ahead of print]

The often difficult decision of which patients will benefit from dialysis.

Brown MA, Crail SM.

Source

Depts Renal Medicine and Medicine, St George Hospital and University of NSW, Sydney, NSW.

Abstract

Nephrologists seek to provide dialysis to those who will benefit most while being honest and direct with those who are unlikely to benefit or even be harmed by dialysis; these can be difficult decisions A 'conservative' or 'not for dialysis' pathway is an important option for the management of ESKD patients who are elderly, have significant co-morbidity, poor functional status, malnutrition or who reside in a nursing home. Such a pathway is best underpinned by a specific Renal supportive Care program in each Unit. Nephrologists need to lead realistic discussions about likely survival with patients and their families before dialysis is instituted. Key ethics principles are a good aid in this decision making process A 'non-dialysis' renal supportive care program is a very positive way of offering holistic care for patients and their families; many of these patients live much longer without dialysis than might have been expected.