[Patients with end-stage chronic renal insufficiency on programmed withdrawal from dialysis].
The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century. The dialysis population is aging and they have multiple medical problems. The choice may be between prolongation of quantity or quality of life. We evaluated a protocol for initiation of dialysis in patients with end stage renal failure and their subsequent withdrawal. We determined the factors predicting withdrawal of dialysis and revised the protocol to take account of these. We carried out an opinion poll of doctors and nurses about the effectiveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years.


RESULTS
Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years. Vascular nephropathy is the principal disease predicting withdrawal from dialysis; the main precipitating cause is mental incapacity. The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal calm when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.
Rodríguez Jornet
A
A
Unidad de Nefrología Corporación Parc Taulí C/Parc Taulí, s/n Apdo. Correos 196 08028 Sabadell.
García García
M
M
Hernando
P
P
Ramírez Vaca
J
J
Padilla
J
J
Ponz
E
E
Almirall
J
J
Rué
M
M
Martínez Ocaña
J C
JC
Yuste
E
E
Cañellas
M
M
Ciurana
J M
JM
Royo
C
C
García Moreno
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D004992:Ethics, Medical; D005066:Euthanasia, Passive / Q000523:psychology; D005190:Family; D005260:Female; D006801:Humans; D007258:Informed Consent; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D018447:Medical Futility; D016743:Mental Competency; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009369:Neoplasms / Q000401:mortality; D009726:Nurses / Q000523:psychology; D016134:Organizational Policy; D010344:Patient Advocacy; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D016079:Refusal to Treat; D006435:Renal Dialysis; D012297:Right to Die; D013030:Spain / Q000453:epidemiology; D013727:Terminal Care / Q000458:organization & administration*; D016312:Treatment Refusal / Q000706:statistics & numerical data