Silva Dirceu Reis da, Gorayeb-Polacchini Fernanda Salomão, Moura Ana Flávia, Rodrigues Cibele Isaac Saad, Younes-Ibrahim Maurício, Rocha Eduardo, Neiva Marina Aline Occhiena de Oliveira, Rocha Pedro Túlio, Abreu Patrícia Ferreira, Moura-Neto José A
Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil.
Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
J Bras Nefrol. 2025 Jul-Sep;47(3):e20250057. doi: 10.1590/2175-8239-JBN-2025-0057en.
Renal failure is considered a life-limiting CONDITION that often requires Renal Replacement Therapy, such as dialysis or kidney transplantation. Dialysis can effectively relieve symptoms and prolong life, but its withdrawal results in severe complications and death. The decision to discontinue or refuse to dialysis must be made collaboratively by the patient, family, and healthcare team, considering the clinical condition, life expectancy, symptom burden, and individual preferences. This decision, involving clinical, bioethical, and legal aspects, is complex and requires a collective understanding of the process. Withdrawal to dialysis presents a challenge for nephrologists and the healthcare team due to the lack of clear guidelines, which can compromis the safety of the process and the patient's dignity. In this position statement, the Brazilian Society of Nephrology recommends a process for dialysis withdrawal or refusal, including identifying eligible patients, applying prognostic assessment tools, shared decision-making, advance care planning, and offering dialysis alternatives. The decision must be consensual, allowing adequate time for reflection, and healthcare services must provide comprehensive management of physical, psychological, social, and spiritual symptoms, as well as end-of-life care. Proper documentation in medical records is essential to ensure process transparency. Therefore, refusal or withdrawal to dialysis should be an informed decision that respects individual autonomy and balances clinical, bioethical, spiritual, and legal considerations.
肾衰竭被视为一种危及生命的疾病，通常需要进行肾脏替代治疗，如透析或肾移植。透析可以有效缓解症状并延长生命，但停止透析会导致严重并发症和死亡。停止或拒绝透析的决定必须由患者、家属和医疗团队共同做出，要考虑临床状况、预期寿命、症状负担和个人偏好。这一决定涉及临床、生物伦理和法律等方面，非常复杂，需要对整个过程有共同的理解。由于缺乏明确的指导方针，停止透析对肾病学家和医疗团队来说是一项挑战，这可能会损害该过程的安全性和患者的尊严。在本立场声明中，巴西肾脏病学会推荐了一个停止透析或拒绝透析的流程，包括确定符合条件的患者、应用预后评估工具、共同决策、预先护理计划以及提供透析替代方案。该决定必须是双方自愿的，要有足够的时间进行思考，医疗服务必须对身体、心理、社会和精神症状以及临终关怀提供全面管理。在医疗记录中进行适当记录对于确保过程透明度至关重要。因此，拒绝或停止透析应该是一个明智的决定，既要尊重个人自主权，又要平衡临床、生物伦理、精神和法律等方面的考虑。
