title: Caring for Older Patients on Peritoneal Dialysis at End of Life.
abstract: End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and their family to determine lifestyle goals, treatment wishes, and ceilings of care (including resuscitation and dialysis withdrawal). Care should also include symptom identification and management, psychosocial support, and adaptation of dialysis to the ability and needs of the patient. By doing this, quality of life at end of life is achievable.
authors.affiliation: Nephrology Departement, Clinique Edouard Rist, Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Meeus
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK e.a.brown@imperial.ac.uk.
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Brown
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000379:methods*; D011788:Quality of Life; D012297:Right to Die / Q000941:ethics; D013727:Terminal Care / Q000379:methods*; D006113:United Kingdom
keywords: End of life; advance care planning; prognosis