Dialysis Withdrawal: Impact and Evaluation of a Multidisciplinary Deliberation Within an Ethics Committee as a Shared-Decision-Making Model.

Since dialysis withdrawal in maintenance dialysis patients with limited life expectancy results always in short-term death, nephrologists need a referenced process to make their decision. This study reviews 8 years of operation of an Ethics Committee in Nephrology (ECN). The ECN, within a multidisciplinary team, once a month explores cases reported by caregivers when maintaining dialysis seems not to be in the patient's best interest.

Vascular access-induced hand ischemia: risks and safe management.

Hand ischemia is rare but complex and multifactorial. Distal arteriopathy below the vascular access (VA) is responsible in the vast majority of patients and not a problem of high flow of the VA. Therefore, surgical technique should focus on improving blood flow and pressure instead of reducing blood flow.

[Ethics consultation unit in nephrology (UCEN): review of 10 years of operation in the Grenoble area].

The existence of an ethics consultation unit in nephrology (UCEN) gives to the nephrologist the collegiality required to meet the difficulties of therapeutic choice on a legislative level, particularly in indications of stop dialysis. The discussion conducted, outside the emergency, is guided by a tool for reflexion that details successive steps necessary to the identification of elements required for decision-making. Thanks to complementary skills provided by the participants and training acquired, the UCEN can approach other ethic issues encountered during practice such as contrindication for a kidney transplantation or maintenance of conservative treatment, or performing invasive procedures on patients refusing transfusion.

Treatment of hand ischemia following angioaccess surgery using the distal revascularization interval-ligation technique with preservation of vascular access: description of an 18-case series.

Hand ischemia is a rare complication of angioaccess surgery for hemodialysis. Management usually requires ligation of the arteriovenous fistula (AVF). The purpose of this report is to describe our experience with the use of the distal revascularization interval-ligation (DRIL) technique for treatment of ischemia without ligation of the AVF.