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We Offer Renal Replacement Therapy to Patients Who Are Not Benefitted by It
Author(s) -
Holley Jean L.
Publication year - 2016
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12492
Subject(s) - medicine , renal replacement therapy , intensive care medicine , dialysis , life expectancy , clinical trial , palliative care , surgery , nursing , population , environmental health
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 .