Conservative management of ESRF, Palliative
Care and Withdrawal from Dialysis
Patients with progressive renal failure
in whom dialysis is deemed inappropriate or who choose
not to start RRT should continue to receive the benefit
of the resources available to the renal service to provide
a robust support package.
Service level agreements with funding authorities
should recognise the value of anaemia management in alleviating
many of the symptoms of ESRF in patients who are not receiving
RRT.
In the terminal phase of ESRF, a management
plan, including the preferred location of care, should
be agreed with the patient, his/her carer, family and
GP. An 'open door' policy for urgent admission to the
nephrology ward should be agreed with the Primary Care
Team, District Nurses and the local palliative care services.
Links with Hospices and agencies involved
in terminal care should underpin a culture of 'openness'
in the renal service in which patients can feel free to
discuss withdrawal from dialysis and in which they can
feel confident that care will be appropriate to allow
death with respect and dignity.
