Withdrawal of Renal Replacement Therapy: The Role of Palliative Care
DOI:
https://doi.org/10.71749/pkj.112Keywords:
Advance Care Planning, Decision Making, Kidney Failure, Chronic, Palliative Care, Patient Care Planning, Renal Dialysis, Renal Replacement Therapy, Withholding TreatmentAbstract
Introduction: With aging populations and wider access to renal replacement therapy (RRT), more patients undergo dialysis, often with declining quality of life, leading to consideration of RRT withdrawal. Early integration of palliative care (PC) is essential to ensure a patient-centered approach. This study evaluates the clinical course of patients admitted to a university hospital PC unit who had RRT withdrawn.
Methods: Retrospective observational study of all patients admitted to a hospital-based Palliative Care Unit (PCU) in Portugal with RRT suspension from September 2018 to February 2024. Patient demographics, clinical course, symptoms, complications, and management were analysed.
Results: Twenty-seven patients were included (59% male; mean age 77.4 years). Almost all had ≥1 cardiovascular risk factor; common comorbidities included heart failure (51.9%), cerebrovascular disease (48.2%), and active neoplasia (48.2%). RRT was withdrawn in 77% due to irreversible consciousness impairment or hemodynamic instability. Nephrology (100%) and PC (92.3%) were the most involved specialties. Most patients (81.5%) had ≥3 symptoms, primarily asthenia (85.2%), anorexia (81.5%), dyspnea (70.4%), and pain (66.7%); many presented before RRT withdrawal. Post-withdrawal, constitutional symptoms increased. Mean PC follow-up was 13.4 days; median survival was 12 days. All but one patient died in the hospital.
Conclusion: Short PC follow-up and limited patient involvement in RRT withdrawal decisions (22%) highlight the vulnerability of this population and late referral to palliative care. Earlier integration and proactive advance care planning are critical to optimizing patient-centered decision-making and symptom management.
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Data Availability Statement
The data supporting the findings of this retrospective study were derived from medical records of patients admitted to the Palliative Care Unit of Centro Hospitalar Universitário de São João. Due to patient confidentiality and institutional regulations, these data are not publicly available. De-identified data may be made available from the corresponding author upon reasonable request and with appropriate ethical approval.
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Copyright (c) 2025 Joana Gomes da Cunha, Joana Rema, Edna Gonçalves
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