Bioética en pacientes renales crónicos avanzados con terapias de soporte renal sustitutivo: hemodiálisis, diálisis peritoneal y trasplantes

Abstract

Chronic kidney disease is a multifactorial process of a progressive and irreversible nature which frequently leads to a advanced state, and requires substitutive renal support therapies. The number of patients with end-stage renal disease is increasing worldwide, with an increasing demand for healthcare services. Being many of them candidates for palliative care, due to their chronic, advanced and life-limiting illness.

Patients and their families need to make early decisions for the end of life from the moment of diagnosis of the advanced illness, through the advance directive document, adequacy of the therapeutic effort and palliative care, a decision that will be based on adequate dialogic information that recognizes autonomy and respects the dignity and fundamental rights of the patient expressed through informed consent seeking the best good and quality of life.

Patients who opt for renal replacement support therapies know that their lives depend on the periodicity and compliance to hemodialysis, peritoneal dialysis or a successful kidney transplant, as well as the control of other pathologies associated with their disease. In order to know the bioethical aspects related to end-stage renal disease, a non-systematic review was carried out and rights, judgment values and proportionality for ethical decision-making were defined.

The objective was to know the bioethics in advanced chronic renal patients with renal replacement support therapies: hemodialysis, peritoneal dialysis and transplants.