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END-OF-LIFE CARE IN ELDERLY PATIENTS WITH END-STAGE RENAL DISEASE - ETHICAL AND CLINICAL ISSUES
Abstract
Background: Despite the remarkable technical advances in renal nursing and renal replacement therapy, mortality and morbidity remain high in patients with chronic kidney disease, fact particularly true in older patients with end-stage renal disease (ESRD), who often have a great number of coexisting diseases. In this population, life expectancy and quality of life may be rather poor, raising important ethical issues about the decision of initiating or withdrawing renal replacement therapy. Aim of study: was to evaluate end-of-life care preferences and expectations of patients, especially in the elderly, and to help develop future guidelines in end-of-life care and palliative care policy for ESRD patients.Material and methods: A number of 256 stage 5 (including stage 5D and 5T) CKD patients were monitored in our Nephrology department, between January 2013 and February 2015. Data included primary disease as cause of end-stage renal disease, co-morbidities, type of dialysis, reason for withdrawal, as well as survival time after withdrawal. Results: More than 60\% of the patients were over 65 years old. Around 25\% of the study group were cognitively impaired at the time of the withdrawal decision, and only 25.4\% dialysis patients regretted their decision to start renal replacement therapy. A number of 22 patients (8.6\%) decided to withdraw from dialysis and were followed by a palliative care team. Mean survival time was 15 days. The most frequent symptoms following withdrawal were: dyspnea, hemorrhages, neuro-psychiatrical symptoms and pain. Support measures used to correct hydroelectrolytic and acid-base alterations, benzodiazepines and opioids, as well as psychological support, were used in the treatment of all patients. Conclusions: The elements of end-of-life care that patients require include greater education and support for medical staff, patients, and their families with respect to end-of-life issues and possibility to choose between conservative care and dialysis treatment in the elderly, after being aware about their prognosis in both situations. Palliative medicine has the potential to improve the care of the patients that discontinue renal replacement therapy. Acknowledgments: This work was realized in the project POSDRU/159/1.5/S/135760
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