What Are Ethical Issues When Honoring an Older Adult's Decision to Withdraw from Dialysis?

Over the next decade, nephrology nurses will witness a continual growth of older adults undergoing hemodialysis. At some point after initiating dialysis, some people will request withdrawal from dialysis, which can present ethical challenges for nurses as they engage in shared decision-making with the patient, family, and other healthcare professionals. This article presents an older adult's story from initiation of dialysis to withdrawal from dialysis and discusses an approach to address ethical issues related to withdrawal from dialysis.

The perfect storm: older adults and acute kidney injury.

Older adults have a high risk for acute kidney injury (AKI), often necessitating critical care admission. The majority of older adults live with 1 or more chronic conditions requiring multiple medications, and when faced with acute illness increased vulnerability can lead to poor health outcomes. When combined with circumstances that exacerbate chronic conditions, clinicians may witness the perfect storm. Some factors that contribute to AKI risk include the aging kidney, sepsis, polypharmacy, and nephrotoxic medications and contrast media. This paper discusses specific risks and approaches to care for older adults with AKI who are in critical care.

Vitamin D deficiency in the sunshine state.

Vitamin D is well known for its skeletal and extraskeletal benefits. Chronic kidney disease (CKD), even in the early stages, may predispose patients to vitamin D deficiency, which may result in deleterious effects. Understanding the prevalence of vitamin D deficiency in the CKD population living in southern areas of the United States may help in early identification and implementation of preventative strategies.