dialysiswith - 67 yo male presenting with hypertensive...

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67 yo male presenting with hypertensive emergency, aki on ckd requiring dialysis. No improvement in ms x 1mth (non verbal/unresponsive) with family insisting on continuing dialysis. Questions: -What could have been done prior to starting to hd? -What can be done now? -Are there guidelines to help guide renal care team?
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WITHDRAWAL OF DIALYSIS SONIKA PURI
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BACKGROUND ESRD program- required dialysis centres ‘to screen the appropriateness of pts for dialysis and transplant. 1990s there was growing concern that dialysis population was increasingly composed of older pts with higher comorbid conditions. Higher symptom burden and shorter life expectancy.
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Dialysis withdrawal is the third leading cause of death in pts with esrd – 22%-26% of pts Decision to withdraw dialysis are both ethical and legal. Ethical basis-principle of individual autonomy. Legal basis –right of self determination and constitutional right of liberty.
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PHYSICIAN FACTORS:
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Variation in attitudes of dialysis unit medical directors towards withholding and withdrawing dialysis; Moss et al, JASN 1993 National wide survey of 594 medical directors on dialysis units; 303 responded. 63% units were not attached to any hospital, mean number of hd pts 100 +/- 81, median-76. 70% indicated that they would take help of ethics committee.
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Nephrologists’ experience with and attitudes towards decisions to forego dialysis ; Singer, JASN 1992 Questionnaires were sent to 161 nephrologists in six states in New England area 118 responded; not everyone answered all questions. Response rate of 73% Questions were regarding how the nephrologists would respond to the following hypothetical scenarios- A competent patient requesting dialysis to be stopped Family of irreversibly incompetent pt requesting dialysis to be stopped with clear evidence that pt had requested dialysis to be held in his/her current situation. Situation 2; no
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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dialysiswith - 67 yo male presenting with hypertensive...

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