Dialysis approach for patients with terminal illnesses in intensive care units

Abstract

Patients with acute kidney injury, and patients on maintenance dialysis, requiring intensive care unit（ICU）admission have a considerably poor prognosis; however, this is more dependent on the comorbidities and illness severity than on the renal failure itself. Clinical practice guidelines on shared decision-making for appropriate initiation and withdrawal from dialysis recommend considering a time-limited trial for patients requiring dialysis. However, the recommendation is for patients with uncertain prognoses or if consensus regarding the usefulness of dialysis cannot be obtained. This has been performed in select patients in the ICU. Ideally, intensivists and nephrologists should collaborate in a time-limited trial of dialysis using each other’s strengths. In patients of prolonged ICU stay, difficult withdrawal from continuous renal replacement therapy, and ethically conflicted cases, we actively hold conferences using the Jonsen’s four topics approach with multiple disciplines, including intensivists and nephrologists, to help determine the best treatment strategy. We intend to introduce our dialysis approach for patients with terminal illnesses in the ICU, based on our experience.