Successful Home Hemodialysis in Purportedly Unacceptable Patients

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Abstract
Uremia therapy may be efficacious in patients liable to be excluded from hospital therapy for reasons such as low intellect, diabetes mellitus and inability to speak English. Cases (4) are described which were successfully treated with home hemodialysis. Of 79 patients undergoing home hemodialysis in this program, 31 (38%) were > 50 yr old when initially evaluated. That home hemodialysis is applicable to less than ideal patients is apparent from the 4 cases cited. While agreement might be obtained among consultants to refuse treatment to comatose patients with advanced malignancy, hopeless senility, or dependency on a respirator, few clinical decisions are so sharply defined. Lacking testable criteria for denying hemodialysis, present practices should be recognized as forced by economic necessity, rather than desirable conduct based on sound medical judgment.

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