Indian Journal of Palliative Care
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Year : 2021  |  Volume : 27  |  Issue : 5  |  Page : 6--10

Decision-making around commencing dialysis

1 Departments of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Division of Palliative Care, National Cancer Grid; Palliative Care, BARC Hospital; Palliative Care and Division of Medical Humanities, KEM Hospital, Mumbai, Maharashtra, India
3 Department of Nephrology, Nanjappa Hospital, Shivamogga, Karnataka, India
4 Department of Nephrology and Renal Transplantation, Postgraduate Institute of Medical Education and Research, Chandigarh, India
5 Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Correspondence Address:
Nandini Vallath
Palliative Care Consultant, National Cancer Grid- India, Tata Memorial Hospital, Parel East, Parel, Mumbai, Maharashtra – 400 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpc.ijpc_61_21

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The decision regarding dialysis initiation is complex. Awareness that renal replacement therapy should not be regarded as default therapy for every patient with advanced renal failure is necessary. Decision to initiate dialysis and modality should be individualized in a shared decision-making process involving the treating nephrologist and the patient. Patients should receive predialysis education early in the course of chronic kidney disease so as to help prepare them well in advance for this eventuality. Withholding dialysis may be a reasonable option in a certain subset of patients, especially elderly patient with multiple co-morbid illnesses. Comprehensive conservation care should be offered in all patients where the decision to not dialyze is taken.


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