RPA releases updated guideline for shared decision-making about dialysis options

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RPA releases updated guideline for shared decision-making about dialysis options
4/5/2011

The Renal Physicians Association has released the second edition of its guideline - http://www.renalmd.org/End-Stage-Renal-Disease/ - to help doctors and kidney disease patients share decision-making about dialysis initiation and withdrawal. Included in the guideline are 19 recommendations for quality in decision-making and treatment of patients with acute kidney injury, chronic kidney disease and end-stage renal disease or kidney failure.

Alvin Moss, MD, presented the recommendations included in the "Renal Physicians Association 2nd edition of its Clinical Practice Guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis" at the association's annual meeting in Washington, DC, in March.

The guideline recognizes the communication challenges in discussing prognosis and treatment options with CKD and ESRD patients and their families and provides strategies to assist nephrologists with it.

According to the RPA, kidney patients may have distinctly different treatment goals based on their overall condition and preferences:
patients may choose aggressive therapy with dialysis without limitations on other treatments;
patients with a poor prognosis may choose dialysis but with limitations on other treatments such as cardiopulmonary resuscitation, intubation, and mechanical ventilation because they want to balance life prolongation and comfort; and
patients may decline dialysis and prefer that the primary goal of their care be their comfort. The guideline recognizes these important distinctions and the need for open discussion.

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