Korean Journal of Nephrology 2008;27(1):85-93.
Application of Advance Directives for Patients with End Stage Renal Disease
Yang Hoon Nam, M.D.1, In Suk Seo, M.D.1, Ji Hwan Lim, M.D.1 , Jun Hyuk Choi, M.D.1 Jang Eon Kim, M.D.1, Jin Ho Choi, M.D.1, Ji Min Oh, M.D., Kyu Heum Kwon, M.D.1 Su-Jin Yoon, M.D.1 and Sung Min Yoon, M.D.2
Department of Internal Medicine1
Hospice2 , Seoul Medical Center
원저 : 말기 신부전 환자에서 사전의사결정서의 적용
남양훈1•서인석1•임지환1•최준혁1•김장언1•최진호1•오지민1•권규흠1•윤수진1•윤성민2
서울의료원 내과1, 호스피스2
Abstract
Purpose : In other countries, government guidelines related to chronic illness are being used to enhance supportive care of renal patients. In Korea, the number of old ages and hemodialysis patients with many complications has been increased. But we don't have any guidelines for palliative care of end stage renal disease. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, renal replacement therapy) via routine use of advance directives in people with end stage renal disease undergoing hemodialysis. Methods : 1) We revised advance directives in Seoul Medical Center. 2) We recommended the routine use of advance directives to patients who were treated in hemodialysis room of Seoul Medical Center from Jan, 2007 to Jun, 2007. So 35 patients were enrolled. 3) They had been interviewed about endof-life treatment plans and filled up advance directives. Results : 23 males and 12 females in total were enrolled. The advance directives include 18 questions about patient preferences for treatment of end-of-life. The majority of hemodialysis patients replied "I will follow doctor's decisions including cardiopulmonary resuscitation and renal replacement therapy" 8 females (67%), 15 diabetes (53%) and 11 geriatric patients above 60yrs old (52%), however, were against cardiopulmonary resuscitation. Conclusion : Routine use of advance directives will provide basic sources for end-of-life decisions in the care of end stage renal patients. And they would like to keep the high quality of life with the help of prepared therapeutic plan of care and well-dying presented advance directives.
Key Words: Advance directives, Hemodialysis, End stage renal disease


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