When enough is enough: the nephrologist's responsibility in ordering dialysis treatments

Am J Kidney Dis. 2011 Jul;58(1):135-43. doi: 10.1053/j.ajkd.2011.03.019. Epub 2011 May 20.


For more than 20 years, nephrologists have been reporting that they are increasingly being expected to dialyze patients whom they believe may receive little benefit from dialysis therapy. During this time, there has been substantial research about the outcomes of patients of differing ages and comorbid conditions requiring dialysis and the development of clinical practice guidelines for dialysis decision making based on research evidence, ethics, and the law. The importance of palliative medicine to the care of the patient throughout the continuum of kidney disease also has been recognized, and its application has been described. This article summarizes these advances and provides an approach for decision making and treatment for patients who are not likely to benefit from dialysis therapy.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Decision Making / ethics
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Male
  • Nephrology / ethics*
  • Palliative Care / ethics*
  • Palliative Care / legislation & jurisprudence
  • Patient Preference
  • Physician's Role*
  • Physician-Patient Relations
  • Practice Guidelines as Topic
  • Professional-Family Relations
  • Prognosis
  • Quality of Life
  • Renal Dialysis / ethics*
  • Renal Insufficiency, Chronic / therapy*
  • Withholding Treatment / ethics
  • Withholding Treatment / legislation & jurisprudence