Nephrology Ethics: “No Dialysis” As a Treatment Option
Bibliographic record
Abstract
Background: Renal failure in elderly patients often generates an ethical question “should dialysis be initiated?” The nephrologists are faced with the dilemma of conveying the prognosis of renal failure in elderly patients and also explain the pros and cons of offering a renal replacement therapy (RRT). Methods: We report a retrospective study conducted between 6/2001 and 6/2003 to evaluate the clinical situations where initiating RRT was considered inappropriate. All patients who opted for not initiating/withdrawal of RRT were included in the study. Results: Twenty‐four patients were included in the study. All patients were males with average age 70.7 years. 17/24 were in the intensive care unit. Complex medical illnesses with poor quality of life were the major reasons for opting out of RRT. 20/24 patients opted for not initiating RRT and 3/24 patients opted for withdrawal. 1/24 opted for a trial of RRT before taking long‐term decisions. 3/20 who opted against initiating RRT had advanced directives. 18/20 who opted for not initiating RRT died within 3 days of the need for RRT, 2/20 are alive without RRT after 6 and 4 months with estimated GFR of 14 and 12 mL/min, respectively. Patient who opted for a trial of RRT died eventually, 4 months after a prolonged bedridden stay in a nursing home. 3/3 ESRD patients died within a week after withdrawing dialysis. Conclusion: The decision to initiate RRT should be made considering the overall prognosis. A decision to not initiate or withdraw RRT is possible in critically ill patients and if taken judiciously can reduce physical and mental stress of both patient and their family members.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.048 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.012 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".