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. 2014 Dec 5;9(12):2203-9.
doi: 10.2215/CJN.00650114. Epub 2014 Aug 7.

A palliative approach to dialysis care: a patient-centered transition to the end of life

Vanessa Grubbs  1 , Alvin H Moss  2 , Lewis M Cohen  3 , Michael J Fischer  4 , Michael J Germain  5 , S Vanita Jassal  6 , Jeffrey Perl  7 , Daniel E Weiner  8 , Rajnish Mehrotra  9 ; Dialysis Advisory Group of the American Society of Nephrology
Collaborators, Affiliations

A palliative approach to dialysis care: a patient-centered transition to the end of life

Vanessa Grubbs et al. Clin J Am Soc Nephrol. .

Abstract

As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.

Keywords: dialysis; end of life; palliative care.

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Figures

Figure 1.
Figure 1.
As the patient nears the end of life (dashed arrow), there is an increasing focus on symptom control and patient goals of care and a shift in the approach to dialysis care from conventional to palliative. Adapted from Institute of Medicine (59).
See this image and copyright information in PMC

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