Voluntary discontinuation of dialysis

The voluntary discontinuation of dialysis by patients is a common mode of d eath in dialysis programmes. Unfortunately the Spanish experience has not b een related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21(st) century. T he dialysis population is ageing and they have multiple medical problems. T he choice may be between prolongation of quantity or qualify of life. We ev aluated a protocol for initiation of dialysis in patients with end stage re nal failure and their subsequent withdrawal. We determined the factors pred icting withdrawal of dialysis and revised the protocol to take account of t hese. We carried out an opinion poll of doctors and nurses about the effect iveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years. Results: Thirty patients were withdrawn from dialysis out of 116 who died d uring treatment by hemodialysis or continuous ambulatory peritoneal dialysi s (CAPD) in the last seven years. Vascular nephropathy is the principal dis ease predicting withdrawal from dialysis; the main precipitating cause is m ental incapacity The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal cal m when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.