Deciding not to start dialysis--a one year prospective study in Teesside.
OBJECTIVE
To study the number and type of patients in whom it was decided not to commence dialysis for presumed irreversible renal failure, and the reasons for those decisions.


METHODS
A prospective twelve-month observational study. Information, regarding the decision making process, was obtained by proforma from the doctors involved. Patient details were retrieved from case notes.


METHODS
The South Cleveland Hospital Renal Unit, which is the sole provider of chronic dialysis for a catchment population of 900,000 in Teesside and parts of South Durham and North Yorkshire.


METHODS
Patients referred for consideration for dialysis for presumed irreversible renal failure in whom it was decided not to commence dialysis. Data are included regarding all patients who did commence renal replacement therapy for end-stage renal failure over the same time period for demographic comparison.


RESULTS
Eleven patients did not start dialysis, compared with 88 commencing RRT. In the undialysed patients, age range was 56 to 90, but six were 80 or over. Only one had previously attended a renal clinic, none had a specific renal diagnosis. Only 3 had no immediate indications for dialysis. Six patients were thought likely to die soon with or without dialysis. All 11 had significant co-morbidity, and 6 were recorded as housebound. Four patients were totally incapable of making a decision regarding dialysis; only one of the other seven was offered the choice. During the study period, both the acceptance rate and the early death rate for dialysis were higher than in previous years.


CONCLUSIONS
A small number of patients with multiple medical and social problems are not selected for dialysis. Although some would have had their life prolonged by dialysis, about half were thought to be about to die from non-renal causes. The patients were rarely involved in the decision making process. The process of being studied may have altered either decision making or classification of patients being offered dialysis.
Main
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Renal Unit, South Cleveland Hospital, Middlesbrough, England.
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013997:Time Factors; D006113:United Kingdom