Moura José Andrade, Moura Ana Flávia de Souza, Suassuna José Hermógenes Rocco
Universidade do Estado do Rio de Janeiro.
Escola Brasileira de Administração Pública e de Empresas - FGV.
J Bras Nefrol. 2017 Jul-Sep;39(3):312-322. doi: 10.5935/0101-2800.20170054.
Renouncement of renal replacement therapy (RRT) is a medical dilemma. This review covers the concept, the magnitude, the prognosis, and discusses strategies and management approaches about this subject in patients with CKD and AKI. Evidence suggests that refusal is more frequent and carries a more guarded prognosis than withdrawal of RRT. When RRT is not expected to be beneficial in terms of survival or quality of life, conservative treatment and palliative care are alternatives. We review the historical evolution of guidelines about renouncement of RRT and palliative care, and highlight the absence of specific recommendations in Brazil. However renouncement of RRT may be ethically and legally accepted in Brazil, as the right to a dignified death. Longer life expectancy, economic pressures, and greater awareness will require a more detailed discussion about indications and sustainable use of RRT, and possibly the elaboration of national guidelines.
放弃肾脏替代治疗（RRT）是一个医学难题。本综述涵盖了这一概念、规模、预后，并讨论了慢性肾脏病（CKD）和急性肾损伤（AKI）患者关于该主题的策略和管理方法。有证据表明，与停止RRT相比，拒绝接受RRT更为常见，且预后更不容乐观。当RRT在生存或生活质量方面预计无益处时，保守治疗和姑息治疗是替代方案。我们回顾了关于放弃RRT和姑息治疗指南的历史演变，并强调巴西缺乏具体建议。然而，在巴西，放弃RRT在伦理和法律上可能被视为尊严死亡的权利而被接受。预期寿命延长、经济压力以及更高的认知度将需要对RRT的适应症和可持续使用进行更详细的讨论，并可能需要制定国家指南。
