Ethical issues in the care of the patient with end-stage renal disease
- Holly M Koncicki, MD
Holly M Koncicki, MD
- Assistant Professor
- Icahn School of Medicine at Mount Sinai
- Lionel U Mailloux, MD, FACP
Lionel U Mailloux, MD, FACP
- Clinical Professor of Medicine
- Hofstra Northwell School of Medicine
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- R Sean Morrison, MD
R Sean Morrison, MD
- Section Editor — Selected End Stage Conditions
- Hermann Merkin Professor of Palliative Care
- Mount Sinai School of Medicine
Although dialysis successfully treats patients with end-stage renal disease (ESRD), there are patients who have additional clinical characteristics that draw into question the appropriateness or continuation of such therapy. Not every patient benefits from renal replacement therapy to the same degree.
The universal availability of dialysis in the United States allows the nephrologist to consider its application in every patient in whom it might be indicated. In this setting, each patient and clinical setting must be judged individually . As an example, the issues and concerns surrounding a 45-year-old patient with adult polycystic kidney disease are entirely different from those of a 90 year old with severe arteriosclerosis.
The general ethical issues surrounding the dialytic or conservative care of patients with ESRD are presented in this topic review. Issues regarding kidney transplantation are discussed elsewhere. (See "Evaluation of the potential renal transplant recipient".)
Practical considerations regarding the decision to forego dialysis and the ongoing medical care of patients who forego dialysis are discussed separately. (See "Withdrawal from and withholding of dialysis" and "Conservative care of end-stage renal disease".)
ETHICAL FRAMEWORK IN DECISION MAKING
Decisions involving the initiation or maintenance of dialysis, particularly among patients who are suboptimal candidates for chronic dialysis therapy, involve several ethical principles, collectively called principalism . (See "Ethical issues in palliative care", section on 'Applying principlism in palliative care'.)
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- ETHICAL FRAMEWORK IN DECISION MAKING
- Application of ethical principles to decisions regarding dialysis
- EDUCATION AND COMMUNICATION WITH THE PATIENT
- Importance of communication
- How to communicate
- Quality of life
- ADVANCE CARE PLANNING AND ADVANCE DIRECTIVES
- Benefits of advance care planning in dialysis patients
- SUMMARY AND RECOMMENDATIONS