Palliative dialysis: a change of perspective.

Abstract

The aging phenomenon of dialysis patients is a worldwide reality, observed in developed and developing countries. Those patients have high incidence of chronic conditions along with high mortality rates and for some of them a decline in functional status within the first 12 months of dialysis therapy. Nevertheless, the elderly dialysis patients represent a very heterogeneous group where prognostic tools may help the decision-making process together with family members, medical staff and the patients. Despite the fact that there are many validated prognostic tools in elderly population, no score has the aim to guide the decision to withhold or withdrawn the dialysis procedure; therefore, in many cases, a time-limited trial is supported. After the failure of improvement in life quality and certitude of the poor prognosis, the withdrawing from renal replacement therapy can be done. Medical literature, from developed countries, brings robust evidence that the process of withdrawing the dialysis procedure, after a fail in the so-called “time-limited trial”, along with good quality palliative care in this scenario is related to a good quality of death. We, on the other hand, believe that the withdrawing process in countries where hospice and good palliative care is not a reality may be associated with bad outcomes. Therefore, this review discusses a way to improve end-of-life symptoms in countries where palliative care facilities are not a reality, the so-called “palliative dialysis”.