Discontinuing dialysis is an accepted practice.
Dialysis it can be stopped when it is no longer achieving a meaningful goal for the patient. Its goal is to maintain a patient’s quality of life at an acceptable level.
Discussions to stop dialysis typically occur when:
• it is no longer serving to substantially prolong life, or is only prolonging a patient’s end-of-life stage; or
• its burdens and complications outweigh its life-prolonging benefits.
Patient characteristics associated with dialysis withdrawal are: older age, female, white race, longer duration of dialysis, higher educational level, living alone, severe pain, and comorbidity (with chronic or progressive diseases). Reported prevalence levels of patient decision-making capacity at the time of withdrawal vary considerably (37% to 80%), suggesting cognitive failure drives many of these decisions.
For patients not close to death that request to stop dialysis, reasons for withdrawal must be explored, especially for treatable and ameliorable factors that might contribute to the desire to withdraw dialysis. These include:
• inadequately treated depression, anxiety, pain, and other physical or psychological symptoms;
• dissatisfaction or difficulties with dialysis itself (e.g., modality, time commitment, or treatment setting); and
• inadequate social support, or concerns with being a burden to loved ones.
If a patient’s quality of life can be improved, these concerns must be evaluated and, if possible, treated during a time-limited trial.
See reference for more information. Adapted from Davison SA & Rosielle DA. Withdrawal of dialysis: decision making. Palliative Care Network of Wisconsin. Fast facts and concepts #207. Internet. Accessed on June 24, 2019.
