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, Almirall J, Rué M, Martínez Ocaña JC, Yuste E, Cañellas M, Ciurana JM, Royo C, and García Moreno S
- Subjects
- Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Cardiovascular Diseases mortality, Cause of Death, Comorbidity, Dementia epidemiology, Ethics, Medical, Family, Female, Humans, Informed Consent, Kidney Failure, Chronic mortality, Male, Medical Futility, Mental Competency, Middle Aged, Multiple Organ Failure mortality, Neoplasms mortality, Nurses psychology, Patient Advocacy, Peritoneal Dialysis, Continuous Ambulatory, Physicians psychology, Prospective Studies, Right to Die, Spain epidemiology, Treatment Refusal statistics & numerical data, Euthanasia, Passive psychology, Kidney Failure, Chronic therapy, Organizational Policy, Refusal to Treat, Renal Dialysis, Terminal Care organization & administration
- Abstract
Unlabelled: 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 We studied prospectively the reasons for death of patients in the last seven years., Results: Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years.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.
- Published
- 2001