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It is sometimes right not to provide RRT where it would not enhance the quality and/or duration of life. 

Such decisions should be made explicitly, after discussion with relevant parties, and recorded.  The level of the patient’s involvement should be clear.  GPs should always be involved in decisions concerning long term care, but not necessarily in acute illnesses where dialysis is being withheld primarily because of factors other than renal failure itself (e.g. other fatal illness).  The views of relatives frequently inform a decision, and discussions should be noted, but relatives cannot make decisions on behalf of a mentally competent adult, or overrule a decision which is medically clearly correct. 

Patients who are uncertain, or who have elected not to have dialysis, should be referred to the conservative care specialist nurse/team. 

 

Further information

 

Acknowledgements:   Neil Turner was the main author for this page. The last modified date is shown in the footer.

 

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