The Hidden Complexity of Dialysis Withdrawal: A Case Report

Autores

DOI:

https://doi.org/10.71749/pkj.94

Palavras-chave:

Kidney Failure, Chronic, Palliative Care

Resumo

Kidney supportive care (KSC) incorporates palliative care principles into nephrology, encompassing the full spectrum of kidney disease. Dialysis withdrawal, a component of kidney supportive care (KSC), presents a challenging, complex, and emotionally demanding therapeutic option. As patients experience increasing physical dependence on treatment, healthcare professionals may avoid or defer discussions regarding its withdrawal, making it more difficult for patients and their families to cope with decisions regarding end­ ‑of­ ‑life care.

The ideal withdrawal involves a carefully considered, patient­ ‑centered decision to minimize suffering and psychological discomfort for the family. This case report details the management of a patient with end­‑stage chronic kidney disease on kidney replacement therapy whose dialysis was temporarily suspended due to an initial misdiagnosis of cancer. It underscores the critical importance of multidisciplinary collaboration and the challenges of complex therapeutic decisions such as dialysis withdrawal, especially in an inpatient setting.

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Referências

(1) Gelfand SL, Scherer JS, Koncicki HM. Kidney Supportive Care: Core Curriculum 2020. Am J Kidney Dis. 2020;75(5):793-806. doi:10.1053/j.ajkd.2019.10.016

(2) Brennan F, Brown MA. Palliative Care for Hemodialysis Patients?. Clin J Am Soc Nephrol. 2022;17(10):1433-1435. doi:10.2215/CJN.09710822

(3) Bansal AD, Schell JO. Strategies to address clinician hesitancy toward conservative care. Nephrol Dial Transplant. Published online November 23, 2018. doi:10.1093/ndt/gfy339

(4) Hussain JA, Flemming K, Murtagh FE, Johnson MJ. Patient and health care professional decision-making to commence and withdraw from renal dialysis: a systematic review of qualitative research. Clin J Am Soc Nephrol. 2015;10(7):1201-1215. doi:10.2215/CJN.11091114

(5) Chen JHC, Brown MA, Jose M, Brennan F, Johnson DW, Roberts MA, et al. Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation-a cohort study. Nephrol Dial Transplant. 2022;37(4):760-769. doi:10.1093/ndt/gfab207

(6) Hamroun A, Speyer E, Ayav C, Combe C, Fouque D, Jacquelinet C, et al. Barriers to conservative care from patients' and nephrologists' perspectives: the CKD-REIN study. Nephrol Dial Transplant. 2022;37(12):2438-2448. doi:10.1093/ndt/gfac009

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Publicado

2025-06-03

Edição

Secção

Case Report

Como Citar

The Hidden Complexity of Dialysis Withdrawal: A Case Report. (2025). Revista Portuguesa De Nefrologia. https://doi.org/10.71749/pkj.94

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