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End-of-Life Decision Making in Older Patients with Acute Kidney Injury and End-Stage Renal Disease: Ethical Perspectives

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Managing Renal Injury in the Elderly Patient

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Abstract

End-of-life discussions with older patients facing the prospect of dialysis are challenging and require acknowledgement of and respect for ethical principles. Medical advancements and the development of life-sustaining interventions often require patients to make difficult decisions about options for medical care in times of immense emotional distress. The decision to start dialysis because of acute kidney injury (AKI) may pose an ethical dilemma in the case of some older patients; similarly, older patients with unexpectedly rapid progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) may have comorbid conditions that undermine the success of dialysis in prolonging quality in addition to quantity of life. Finally, continuing to dialyze patients whose functional or clinical status has declined poses an ethical dilemma for nephrologists, especially when patients are no longer able to participate in decisions about their own care. This chapter explores the ethical aspects of end-of-life decision making in older patients facing major life transitions and decisions related to (1) the pursuit of dialysis because of AKI, (2) the consideration of dialysis when there is progression of CKD to ESRD, and (3) the continuation or withdrawal of dialysis in patients whose clinical status has changed since the initiation of dialysis.

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Authors and Affiliations

  1. WVU Section of Nephrology, Department of Medicine/Nephrology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA

    Sana R. Akbar MD & Rebecca J. Schmidt DO, FACP, FASN

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  1. Sana R. Akbar MD
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  2. Rebecca J. Schmidt DO, FACP, FASN
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Correspondence to Sana R. Akbar MD .

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Editors and Affiliations

  1. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Michael Haase

  2. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Anja Haase-Fielitz

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Akbar, S.R., Schmidt, R.J. (2014). End-of-Life Decision Making in Older Patients with Acute Kidney Injury and End-Stage Renal Disease: Ethical Perspectives. In: Haase, M., Haase-Fielitz, A. (eds) Managing Renal Injury in the Elderly Patient. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39947-3_9

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  • DOI: https://doi.org/10.1007/978-3-642-39947-3_9

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-39946-6

  • Online ISBN: 978-3-642-39947-3

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