The number of patients diagnosed with end-stage
kidney disease (ESKD) continues to grow around the
world. In developed countries, renal replacement
therapy is widely available. A critical issue for any
individual patient is whether dialysis is the most appropriate
management. In 2010, the Renal Physicians
Association of the USA published Shared DecisionMaking
in the Appropriate Initiation of and
Withdrawal from Dialysis1 which stated that it would
be ‘appropriate to forego’
1 or ‘reasonable to consider
foregoing’
1 dialysis (withholding or withdrawing) in
certain circumstances and, further, that a conservative
management of ESKD was both medically and ethically
defensible. Similar conclusions have been drawn
in an Australian and New Zealand consensus
document.2