Adequacy of Therapeutic Effort as a Crucial Competence in Nephrology: Case Report

Abstract

The current availability of multiple life support technologies, like chronic kidney support in an outpatient setting, frequently masks fragile conditions and complicates the process of decision‑making in end‑of‑life. To avoid disproportionate interventions that prolong suffering, adequacy of therapeutic effort (ATE) is a process that aligns therapeutic interventions with the patient’s clinical status, prognosis and wishes, respecting the natural course of life. In this paper, we present a case of a 44‑year‑old female with critical heart and kidney failure for which an ATE process was applied along the patient’s clinical course. In the end, we review the main barriers to ATE implementation. Training palliative care competencies among professionals and developing guidelines and juridical clarification sessions can be crucial pillars for the implementation of ATE in the Nephrology field. This topic is of particular importance, especially in a country like Portugal, where renal replacement therapy remains highly prevalent.