title: [Quality end of life in uremic patients: theory and practice].
abstract: The rate of fragile elderly patients affected by chronic kidney disease stage 5-5D is rapidly increasing. The decision making process regarding the start and the withdrawal of dialysis is often difficult for all those involved: patients, relatives, nephrologists and renal nurses. Therefore nephrologists and renal nurses are called to rapidly improve their theoretical and practical competence about the end-of-life care. The quality of clinical intervention and management requires a sound expertise in the ethical, legal, organizational and therapeutic aspects, not trivial nor even deductible from purely private and individual opinions nor from traditional medical practice. The present paper discusses the ethical and legal implications related to the start rather than to withdrawn from dialysis, preferring a non-dialysis medical treatment and / or palliative care. Operational aspects regarding the regional network of palliative care, the path of shared decision making process and a systematic approach to optimize medical and nursing interventions through the Liverpool Care Pathway program are discussed thereafter.
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.forename: Maria Enrica
authors.initials: ME
authors.lastname: Giovenzana
authors.forename: Federico
authors.initials: F
authors.lastname: Prolo
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Colombo
authors.forename: Luciano
authors.initials: L
authors.lastname: Orsi
authors.forename: Sergio
authors.initials: S
authors.lastname: Fucci
authors.forename: Loredana
authors.initials: L
authors.lastname: Sorbara
authors.forename: Silvia
authors.initials: S
authors.lastname: Viganò
authors.forename: Chiara
authors.initials: C
authors.lastname: Clementi
authors.forename: Susi
authors.initials: S
authors.lastname: Falcaro
authors.forename: Sara
authors.initials: S
authors.lastname: Auricchio
authors.forename: Beatrice
authors.initials: B
authors.lastname: Dozio
authors.forename: Renzo
authors.initials: R
authors.lastname: Scanziani
mesh_terms: D000066491:Clinical Decision-Making; D000072700:Conservative Treatment; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D010166:Palliative Care; D011788:Quality of Life; D006435:Renal Dialysis / Q000941:ethics; D014511:Uremia / Q000209:etiology / Q000628:therapy; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence