To dialyze or not to dialyze: an ethical and evidence-based approach to the patient with acute renal failure in the intensive care unit.
Patients with acute renal failure in the intensive care unit have high in-hospital mortality. In this setting, decision making with regard to the initiation or discontinuation of dialysis by physicians, patients, and families is challenging because of the desire of all for the patient to recover while sparing unnecessary suffering. Decision making can be facilitated by knowledge of outcomes of the treatment of such patients in the medical literature. This knowledge assists nephrologists to distinguish those patients whose clinical situation indicates a more favorable prognosis from those whose prognosis is uncertain or definitely poor even with dialysis. This information, combined with consideration of relevant ethical guidelines, provides a framework for nephrologists to make decisions that are evidence based and ethically sound. We present and discuss two cases to show the application of evidence-based medicine and ethical considerations to decision making for patients with acute renal failure in the intensive care unit.
MacKay
K
K
Department of Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, USA.
Moss
A H
AH
D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D003657:Decision Making; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D018579:Patient Selection; D006435:Renal Dialysis; D028761:Withholding Treatment