Renouncement of renal replacement therapy: withdrawal and refusal
Abstract Renouncement of renal replacement therapy (RRT) is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Nefrologia
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| Series: | Brazilian Journal of Nephrology |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000300312&lng=en&tlng=en |
| _version_ | 1818022997551742976 |
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| author | José Andrade Moura Neto Ana Flávia de Souza Moura José Hermógenes Rocco Suassuna |
| author_facet | José Andrade Moura Neto Ana Flávia de Souza Moura José Hermógenes Rocco Suassuna |
| author_sort | José Andrade Moura Neto |
| collection | DOAJ |
| description | Abstract Renouncement of renal replacement therapy (RRT) is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines. |
| first_indexed | 2024-12-10T03:37:19Z |
| format | Article |
| id | doaj.art-3f7ea5c7fcf34adcb6913c19c1393602 |
| institution | Directory Open Access Journal |
| issn | 2175-8239 |
| language | English |
| last_indexed | 2024-12-10T03:37:19Z |
| publisher | Sociedade Brasileira de Nefrologia |
| record_format | Article |
| series | Brazilian Journal of Nephrology |
| spelling | doaj.art-3f7ea5c7fcf34adcb6913c19c13936022022-12-22T02:03:41ZengSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology2175-823939331232210.5935/0101-2800.20170054S0101-28002017000300312Renouncement of renal replacement therapy: withdrawal and refusalJosé Andrade Moura NetoAna Flávia de Souza MouraJosé Hermógenes Rocco SuassunaAbstract Renouncement of renal replacement therapy (RRT) is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000300312&lng=en&tlng=endialysisrenal dialysispalliative carebioethicsacute kidney injuryrenal replacement therapygeriatricsmedical futilitywithholding treatmentkidney failure, chronic |
| spellingShingle | José Andrade Moura Neto Ana Flávia de Souza Moura José Hermógenes Rocco Suassuna Renouncement of renal replacement therapy: withdrawal and refusal Brazilian Journal of Nephrology dialysis renal dialysis palliative care bioethics acute kidney injury renal replacement therapy geriatrics medical futility withholding treatment kidney failure, chronic |
| title | Renouncement of renal replacement therapy: withdrawal and refusal |
| title_full | Renouncement of renal replacement therapy: withdrawal and refusal |
| title_fullStr | Renouncement of renal replacement therapy: withdrawal and refusal |
| title_full_unstemmed | Renouncement of renal replacement therapy: withdrawal and refusal |
| title_short | Renouncement of renal replacement therapy: withdrawal and refusal |
| title_sort | renouncement of renal replacement therapy withdrawal and refusal |
| topic | dialysis renal dialysis palliative care bioethics acute kidney injury renal replacement therapy geriatrics medical futility withholding treatment kidney failure, chronic |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000300312&lng=en&tlng=en |
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