Renouncement of renal replacement therapy: withdrawal and refusal

Moura-Neto, José A.; Moura, Ana Flávia; Suassuna, José Hermógenes Rocco

doi:10.5935/0101-2800.20170054

Cited by 6 publications

(5 citation statements)

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“…While guidelines exist for when not to start KRT in adults [25], there is no consensus for children [26]. Although the Brazilian medical ethics code advises against futile treatments in terminal illnesses advocating for the patient or their legal representative's wishes [27], this remains a contentious topic locally because therapy discontinuation practices are not well-established, except in cases of brain death. The absence of a signi cant difference in mortality between public and private hospitals suggests that local governance might not play a pivotal role in AKI outcomes [28].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective

Cleto-Yamane,

Gomes,

Koch-Nogueira

et al. 2024

Pediatr Nephrol

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BackgroundAcute kidney injury (AKI) is a life-threatening condition, particularly in patients at the extremes of age and when kidney replacement therapy (KRT) is required. Worldwide data report 10% and 63% mortality rates in pediatric patients undergoing KRT. MethodsThroughout a 13-year study period this study analyzed data from 693 patients with AKI in Rio de Janeiro, Brazil. ResultsMost patients were male (59.5%), younger than one year of age (55.6%) and were treated at private governance hospitals (76.5%). Sixty-six percent of the subjects had one or more coexisting conditions. Upon admission, pneumonia was the most frequent primary diagnosis, followed by congenital heart disease (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower mortality observed in patients over 12 (50%). Older age was a protective factor against death (HR: 2.35, IQR [1.52-3.62] for neonates). Primary kidney disease was associated with at least a three-fold lower mortality rate.Additionally, the experience of the ICU team was associated with lower mortality (HR: 0.74, IQR [0.60-0.91]), when the hospital treated 20 or more patients over the study period. Among the patients who died, 40% died within 48 hours of KRT initiation. ConclusionsThis study con rms the high mortality rate associated with dialytic AKI in pediatric patients, in middleincome countries. It also highlights early mortality, which may indicate late referral or futility of treatment. These results provide essential data on the main aspects of this disease and may contribute to the planning of measures to improve the outcomes of this condition.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective

Cleto-Yamane,

Gomes,

Koch-Nogueira

et al. 2024

Pediatr Nephrol

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“…Among these, there is evidence of elderly people, with less education, who spent more time on the journey to the dialysis service, with a greater number of self-reported diseases and inadequate sleep. Even population aging and socioeconomic vulnerability, as well as the increase in DM and AH, associated with improvements in the diagnosis of CKD, have been re ected in the increase in cases with CKD (32).…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic, Clinical and Biochemical Factors Associated With the Glomerular Filtration Rate in Patients Newly Admitted to Hemodialysis in Sus

Oliveira

Cotta

Ferreira

et al. 2023

Preprint

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Background Among the chronic conditions with the greatest evidence of a multifactorial nature, both in terms of etiology and progression, Chronic Kidney Disease (CKD) stands out. The present study aims to analyze the relationship between the Glomerular Filtration Rate (GFR) and the biochemical and sociodemographic parameters in individuals recently admitted to hemodialysis.Methods This is a baseline cross-sectional design of the Nephrology Service of the health microregion of Viçosa, Minas Gerais, Brazil. Descriptive, univariate and multiple linear regression analyzes were performed. The Kolmogorov-Smirnov test was used to test the normality of continuous variables. For numeric variables, Student's t and Mann Whitney test were used. All analyzes were performed using IBM SPSS Statistics 23.0 Software.Results Data from 422 patients were included. The mean age at the onset of HD was 64.02 ± 15.21 years. Chronic hypertensive kidney disease represented 33.4% of cases with varied etiology. The average Glomerular Filtration Rate (GFR), calculated using the CKD-EPI formula, was 10.13 ml/min/1.73m² and the average survival time was 52.06 months (± 49.91%). Based on the evaluation of laboratory data, the averages that were not normal according to the recommendations for these patients were serum calcium, hemoglobin, hematocrit, serum albumin and pre-dialysis urea. Based on the results of the univariate analysis, the following variables were included in the multiple linear regression model: gender, marital status, age, nPCR, glucose, albumin, ferritin, and PTH. According to multivariate analysis, gender, marital status, nPCR, glucose and PTH were independently associated with GFR.Conclusion CKD is increasingly highlighted nowadays because it is a CNCD with a high prevalence of hospitalizations and mortality due to its multifactorial and progressive nature. Therefore, by analyzing the relationship between GFR and biochemical and sociodemographic parameters in individuals newly admitted to HD, the present study allows further insights into the mechanisms that will translate into causalities and ways to establish a better prognosis.

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“…With this context in mind, many patients have refused dialysis with the support of their families and physicians. 59 , 60 Patients refusing dialysis have their functions and symptoms relatively under control until two or three months before they die. It is the task of the physician and the multidisciplinary care team to anticipate and identify symptoms and provide the relief needed.…”

Section: Discussionmentioning

confidence: 99%

Conservative management for patients with chronic kidney disease refusing dialysis

Castro¹

2019

Braz. J. Nephrol.

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Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metabolic alterations and symptoms associated to end-stage renal disease is an important element in providing patients with good palliative care. This review aimed to familiarize members of multidisciplinary care teams with the metabolic alterations and symptoms arising from chronic kidney disease treated clinically without the aid of dialysis.

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Renouncement of renal replacement therapy: withdrawal and refusal

Cited by 6 publications

References 0 publications

Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective

Acute kidney injury requiring dialysis in children: a multicentric, emerging country perspective

Sociodemographic, Clinical and Biochemical Factors Associated With the Glomerular Filtration Rate in Patients Newly Admitted to Hemodialysis in Sus

Conservative management for patients with chronic kidney disease refusing dialysis

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