Collaborative end-of-life decision making in end stage renal disease.

Patients newly diagnosed with end stage renal disease are faced with many treatment decisions. The decision-making process should follow some well-defined steps. These start with the decision to initiate dialysis and may end with a 'do not resuscitate' request or even a withdrawal from dialysis. The nephrology team can lead the patient and family through this process by providing timely, realistic information to help them make the best decisions. End-of-life decision making should be a part of the initial long-term care planning done with every patient and family.