Conservative management for patients with chronic kidney disease refusing dialysis

Abstract

Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo diAâlysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disAêase, and socioeconomic status. In sevAêral occasions nephrologists will interÂvene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metaÂbolic alterations and symptoms asÂsociated to end-stage renal disease is an important element in providing paÂtients with good palliative care. This review aimed to familiarize members of multidisciplinary care teams with the metabolic alterations and sympÂtoms arising from chronic kidney disAêase treated clinically without the aid of dialysis.