Palabras clave
Enfermedad renal crónica
problemas éticos
principios y recomendaciones
suspender diálisis
cuidados paliativos (fuente DeCS).
problemas éticos
principios y recomendaciones
suspender diálisis
cuidados paliativos (fuente DeCS).
Cómo citar
1.
Marín Ballestas GA. Bioética: principios y recomendaciones en la aplicación de diálisis - cuidados paliativos. Rev. Colomb. Nefrol. [Internet]. 9 de enero de 2016 [citado 3 de julio de 2024];2(2):137-46. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/212
Resumen
La prevalencia de la enfermedad renal crónica en Colombia ha ido en aumento, llegando a una cifra de 510 pacientes por millón de habitantes. Tanto el inicio como la suspensión de la diálisis es un frecuente tópico de discusión que crea conflicto en la búsqueda de un balance entre calidad y cantidad de vida. Debemos evaluar, entonces, los criterios, principios y recomendaciones a través de los cuales debemos tomar decisiones prudentes al suspender la diálisis en los pacientes, cuando consideramos que sería una terapia fútil. Una vez suspendida la diálisis debemos integrar, como complemento terapéutico, los cuidados paliativos aliviando el dolor y los síntomas.
Citas
1. Bethesda, MD: US Renal Data System. USRDS 2005 Annual Data Report: Atlas of End- Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2005.
2. Amy S. Hackett and Suzanne G. Watnick Division of Nephrology and Hypertension, Oregon Health & Science University, Portland VA Medical Center, Portland, Oregon. Withdrawal from Dialysis in End-Stage Renal Disease: Medical, Social, and Psychological Issues, Seminars in Dialysis. (January, February) 2007;20(1):86-90.
3. Michael J. Germain, MD Lewis Cohen, MD Bay State Medical Center/Tufts University West Springfield, Massachusetts , Supportive Care for Patients With Renal Disease: Time for Action, American Journal of Kidney Diseases, (October), 2001;38(4):884-886.
4. Sgreccia E. Manual de Bioética, Orígenes, difusión y definición de la Bioética, Editorial Diana México, Capítulo primero. pág. 15-42.
5. Maiorca R. University of Brescia and Division of Nephrology, Spedali Civili of Brescia, Brescia, Italy, Ethical problems in dialysis: prospects for the year 2000, Nephrol Dial Transplant 1998: 13 [Suppl 1]: 1–9.
6. Gómez-Pérez R. Problemas morales de la existencia humana, Capítulo 3, Realidades ética fundamentales, pág. 27-34.
7. Tushar J. Vachharajani, Naveen K. Atray Department of Internal Medicine and Nephrology, Overton Brooks Veterans Affairs Medical Center and Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.; Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A. Aging veterans and the end-stage renal disease management dilemma in the millennium. Hemodialysis International 2007; 11:456–460.
8. Schaefer K, Röhrich. The dilemma of renal replacement therapy in patients over 80 years of age. Nephrol Dial Transplant 1999; 14: 35-6.
9. Mallick N, El Marasi A. Dialysis in the elderly, to treat or not to treat? Nephrol Dial Transplant 1999; 14: 37-9.
10. Dominique J, Dany A, Corinne A, Anh-Thu N, Malik T, Grunfeld PJ, et al. Nephrology Unit, Necker Hospital and Universite´ Rene´ Descartes-Paris V, Paris, France; Inserm , Necker Hospital, Paris, France; and Biostatistics, Robert Debre´ Hospital, Paris, France. Octogenarians Reaching End- Stage Renal Disease: Cohort Study of Decision – Making and Clinical Outcomes, J Am Soc Nephrol 14: 1012–1021.
11. Moss AH. MD Center for Health Ethics and Law, Section of Nephrology, West Virginia University, Morgantown, WV, Too Many Patients Who Are Too Sick to Benefit Start Chronic Dialysis Nephrologists Need to Learn to “Just Say No”. American Journal of Kidney Diseases.
2003 (April);41(4):723-732.
12. Jonh H. Galla Renal Physicians Association/American Society of Nephrology Working Group, Washington, DC. Clinical Practice Guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis J Am Soc Nephrol 11: 1340–1342, 2000.
13. Daniel Callaban. Medical futility, medical necessity. The problem- ithout-a-name. Hastings Cent Rep 1991;21(4):30-5.
14. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med 1992;326(23): 1560-64.
15. Lo B Steinbrook RL. Deciding whether to resuscitate. Arch Intern Med 1983;143:1561
16. Congregación para la Doctrina de la Fe. “Declaratio de euthanasia” op.cit., pp 549-550
17. Cohen LM, Germain M, Poppel DM, Woods A, LICSW, Kjellstrand, CM Dialysis Discontinuation and Palliative Care, American Journal of Kidney Diseases,Vol 36, No 1 (July), 2000: pp 140-144
18. Jablonski A. College of Nursing, Seattle University, Seattle, Washington Palliative Care: Misconceptions That Limit Access for Patients with Chronic Renal Disease, Seminars in Dialysis. 2008;21(3):206-209.
19. Pellegrino ED. Emerging Ethical Issues in Palliative Care, JAMA 1998; 279(19):1521-1522
20. Pablo A. Necesidad de los principios, pero cuales principios”, Persona y Bioética. 2003;7(19):70-83.
2. Amy S. Hackett and Suzanne G. Watnick Division of Nephrology and Hypertension, Oregon Health & Science University, Portland VA Medical Center, Portland, Oregon. Withdrawal from Dialysis in End-Stage Renal Disease: Medical, Social, and Psychological Issues, Seminars in Dialysis. (January, February) 2007;20(1):86-90.
3. Michael J. Germain, MD Lewis Cohen, MD Bay State Medical Center/Tufts University West Springfield, Massachusetts , Supportive Care for Patients With Renal Disease: Time for Action, American Journal of Kidney Diseases, (October), 2001;38(4):884-886.
4. Sgreccia E. Manual de Bioética, Orígenes, difusión y definición de la Bioética, Editorial Diana México, Capítulo primero. pág. 15-42.
5. Maiorca R. University of Brescia and Division of Nephrology, Spedali Civili of Brescia, Brescia, Italy, Ethical problems in dialysis: prospects for the year 2000, Nephrol Dial Transplant 1998: 13 [Suppl 1]: 1–9.
6. Gómez-Pérez R. Problemas morales de la existencia humana, Capítulo 3, Realidades ética fundamentales, pág. 27-34.
7. Tushar J. Vachharajani, Naveen K. Atray Department of Internal Medicine and Nephrology, Overton Brooks Veterans Affairs Medical Center and Louisiana State University Health Sciences Center, Shreveport, Louisiana, U.S.A.; Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A. Aging veterans and the end-stage renal disease management dilemma in the millennium. Hemodialysis International 2007; 11:456–460.
8. Schaefer K, Röhrich. The dilemma of renal replacement therapy in patients over 80 years of age. Nephrol Dial Transplant 1999; 14: 35-6.
9. Mallick N, El Marasi A. Dialysis in the elderly, to treat or not to treat? Nephrol Dial Transplant 1999; 14: 37-9.
10. Dominique J, Dany A, Corinne A, Anh-Thu N, Malik T, Grunfeld PJ, et al. Nephrology Unit, Necker Hospital and Universite´ Rene´ Descartes-Paris V, Paris, France; Inserm , Necker Hospital, Paris, France; and Biostatistics, Robert Debre´ Hospital, Paris, France. Octogenarians Reaching End- Stage Renal Disease: Cohort Study of Decision – Making and Clinical Outcomes, J Am Soc Nephrol 14: 1012–1021.
11. Moss AH. MD Center for Health Ethics and Law, Section of Nephrology, West Virginia University, Morgantown, WV, Too Many Patients Who Are Too Sick to Benefit Start Chronic Dialysis Nephrologists Need to Learn to “Just Say No”. American Journal of Kidney Diseases.
2003 (April);41(4):723-732.
12. Jonh H. Galla Renal Physicians Association/American Society of Nephrology Working Group, Washington, DC. Clinical Practice Guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis J Am Soc Nephrol 11: 1340–1342, 2000.
13. Daniel Callaban. Medical futility, medical necessity. The problem- ithout-a-name. Hastings Cent Rep 1991;21(4):30-5.
14. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med 1992;326(23): 1560-64.
15. Lo B Steinbrook RL. Deciding whether to resuscitate. Arch Intern Med 1983;143:1561
16. Congregación para la Doctrina de la Fe. “Declaratio de euthanasia” op.cit., pp 549-550
17. Cohen LM, Germain M, Poppel DM, Woods A, LICSW, Kjellstrand, CM Dialysis Discontinuation and Palliative Care, American Journal of Kidney Diseases,Vol 36, No 1 (July), 2000: pp 140-144
18. Jablonski A. College of Nursing, Seattle University, Seattle, Washington Palliative Care: Misconceptions That Limit Access for Patients with Chronic Renal Disease, Seminars in Dialysis. 2008;21(3):206-209.
19. Pellegrino ED. Emerging Ethical Issues in Palliative Care, JAMA 1998; 279(19):1521-1522
20. Pablo A. Necesidad de los principios, pero cuales principios”, Persona y Bioética. 2003;7(19):70-83.
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