1. [Patients with end-stage chronic renal insufficiency on programmed withdrawal from dialysis]
- Author
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Rodríguez Jornet A, García García M, Hernando P, Ramírez Vaca J, Padilla J, Ponz E, Jaume Almirall, Rué M, Jc, Martínez Ocaña, Yuste E, Cañellas M, Jm, Ciurana, Royo C, and García Moreno S
- Subjects
Adult ,Male ,Attitude of Health Personnel ,Multiple Organ Failure ,Nurses ,Comorbidity ,Patient Advocacy ,Treatment Refusal ,Peritoneal Dialysis, Continuous Ambulatory ,Renal Dialysis ,Cause of Death ,Neoplasms ,Physicians ,Humans ,Ethics, Medical ,Family ,Mental Competency ,Prospective Studies ,Aged ,Aged, 80 and over ,Terminal Care ,Informed Consent ,Right to Die ,Refusal to Treat ,Middle Aged ,Euthanasia, Passive ,Organizational Policy ,Cardiovascular Diseases ,Spain ,Kidney Failure, Chronic ,Dementia ,Female ,Medical Futility - Abstract
The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century. The dialysis population is aging and they have multiple medical problems. The choice may be between prolongation of quantity or quality of life. We evaluated a protocol for initiation of dialysis in patients with end stage renal failure and their subsequent withdrawal. We determined the factors predicting withdrawal of dialysis and revised the protocol to take account of these. We carried out an opinion poll of doctors and nurses about the effectiveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years.Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years. Vascular nephropathy is the principal disease predicting withdrawal from dialysis; the main precipitating cause is mental incapacity. The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal calm when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.