Mortality remains high for seriously ill patients who develop ARF, and dialysis in this population is generally not cost effec- tive. Little is known about the long-term outcome and quality of life of survivors of ARF in ICUs but most patients appear to recover kidney function and enjoy acceptable quality of life. Scoring systems to estimate prognosis in such patients are not perfect but often provide information useful in medical deci- sion-making. The RPA/ASN guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis provides general recommendations to follow when withholding and withdrawing dialysis is considered. Time-limited trials of dialysis with predetermined measures of improvement, reason- able goals and duration of the trial, and ongoing assessment and communication of clinical status with patients, families, and care providers may enhance decision-making, reduce dis- comfort among providers and families, and lead to fewer cases of extended intensive care for seriously ill patients with poor prognoses. Greater awareness and dissemination of the RPA/ ASN guidelines may facilitate decision-making and care of seriously ill patients who develop ARF.
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