<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2976-0526</journal-id>
<journal-title><![CDATA[Portuguese Kidney Journal (PKJ)]]></journal-title>
<abbrev-journal-title><![CDATA[PKJ]]></abbrev-journal-title>
<issn>2976-0526</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Nefrologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2976-05262025000400001</article-id>
<article-id pub-id-type="doi">10.71749/pkj.112</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Withdrawal of Renal Replacement Therapy: The Role of Palliative Care]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cunha]]></surname>
<given-names><![CDATA[Joana Gomes da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rema]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gonçalves]]></surname>
<given-names><![CDATA[Edna]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Local Health Unit Viseu Dão-Lafões Internal Medicine Service ]]></institution>
<addr-line><![CDATA[Viseu ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,São João Hospital and University Center Palliative Care Service ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>39</volume>
<numero>4</numero>
<fpage>1</fpage>
<lpage>7</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2976-05262025000400001&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2976-05262025000400001&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2976-05262025000400001&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  With aging populations and wider access to renal replacement therapy (RRT), more patients undergo dialysis, often with declining quality of life, leading to consideration of RRT withdrawal. Early integration of palliative care (PC) is essential to ensure a patient&#8209;centered approach. This study evaluates the clinical course of patients admitted to a university hospital PC unit who had RRT withdrawn.  Methods:  Retrospective observational study of all patients admitted to a hospital&#8209;based Palliative Care Unit (PCU) in Portugal with RRT suspension from September 2018 to February 2024. Patient demographics, clinical course, symptoms, complications, and management were analysed.  Results:  Twenty&#8209;seven patients were included (59% male; mean age 77.4 years). Almost all had &#8805;1 cardiovascular risk factor; common comorbidities included heart failure (51.9%), cerebrovascular disease (48.2%), and active neoplasia (48.2%). RRT was withdrawn in 77% due to irreversible consciousness impairment or hemodynamic instability. Nephrology (100%) and PC (92.3%) were the most involved specialties. Most patients (81.5%) had &#8805;3 symptoms, primar-ily asthenia (85.2%), anorexia (81.5%), dyspnea (70.4%), and pain (66.7%); many presented before RRT withdrawal. Post&#8209;withdrawal, constitutional symptoms increased. Mean PC follow&#8209;up was 13.4 days; median survival was 12 days. All but one patient died in the hospital.  Conclusion:  Short PC follow&#8209;up and limited patient involvement in RRT withdrawal decisions (22%) highlight the vulnerability of this population and late referral to palliative care. Earlier integration and proactive advance care planning are critical to optimizing patient&#8209;centered decision&#8209;making and symptom management.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Advance Care Planning]]></kwd>
<kwd lng="en"><![CDATA[Decision Making]]></kwd>
<kwd lng="en"><![CDATA[Kidney Failure, Chronic]]></kwd>
<kwd lng="en"><![CDATA[Palliative Care]]></kwd>
<kwd lng="en"><![CDATA[Patient Care Planning]]></kwd>
<kwd lng="en"><![CDATA[Renal Dialysis]]></kwd>
<kwd lng="en"><![CDATA[Renal Replacement Therapy]]></kwd>
<kwd lng="en"><![CDATA[Withholding Treatment]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<collab>KDIGO</collab>
<article-title xml:lang=""><![CDATA[Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease]]></article-title>
<source><![CDATA[Kidney Int Suppl]]></source>
<year>2013</year>
<volume>3</volume>
<page-range>1-150</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<collab>Sociedade Portuguesa de Nefrologia. Gabinete de Registo de Doença Renal Terminal</collab>
<source><![CDATA[]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vinhas]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Aires]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Batista]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Branco]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Brandão]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Nogueira]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[RENA Study Cross-Sectional Study to Evaluate CKD Prevalence in Portugal]]></article-title>
<source><![CDATA[Nephron]]></source>
<year>2020</year>
<volume>144</volume>
<page-range>479-87</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<collab>Direção-Geral da Saúde</collab>
<source><![CDATA[Norma nº 017/2011 de 01/08/2011. Atualização a 14/06/2012: Tratamento conservador médico da insuficiência renal crónica estádio 5]]></source>
<year>2012</year>
<publisher-loc><![CDATA[Lisboa ]]></publisher-loc>
<publisher-name><![CDATA[DGS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<collab>Portugal</collab>
<article-title xml:lang=""><![CDATA[Despacho n.º 12635/2023, de 11 de dezembro, e Despacho n.º 3391/2025, de 17 de março]]></article-title>
<source><![CDATA[Plano de Ação para a Implementação da Estratégia Nacional para a Promoção da Saúde Renal e Cuidados Integrados na Doença Renal Crónica 2023-2026]]></source>
<year>2023</year>
<volume>245</volume>
<page-range>53</page-range><publisher-name><![CDATA[Diário da República]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<collab>Renal Physicians Association</collab>
<source><![CDATA[Shared decision-making in the appropriate initiation of and withdrawal from dialysis: clinical practice guideline]]></source>
<year>2010</year>
<edition>2</edition>
<publisher-loc><![CDATA[Rockville ]]></publisher-loc>
<publisher-name><![CDATA[RPA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Belino]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Neto]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Gonçalves]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pestana]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Supportive care in advanced chronic kidney disease comprehensive conservative care]]></article-title>
<source><![CDATA[Port J Nephrol Hypert]]></source>
<year>2018</year>
<volume>32</volume>
<page-range>123-36</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Belino]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Meng]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Neto]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Gonçalves]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pestana]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Supportive care in advanced chronic kidney disease withholding and withdrawing dialysis therapy]]></article-title>
<source><![CDATA[Port J Nephrol Hypert]]></source>
<year>2018</year>
<volume>32</volume>
<page-range>137-47</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="">
<collab>Sociedade Portuguesa de Nefrologia. Grupo de Trabalho de Tratamento Médico Conservador</collab>
<source><![CDATA[]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gansevoort]]></surname>
<given-names><![CDATA[RT]]></given-names>
</name>
<name>
<surname><![CDATA[Correa-Rotter]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Hemmelgarn]]></surname>
<given-names><![CDATA[BR]]></given-names>
</name>
<name>
<surname><![CDATA[Jafar]]></surname>
<given-names><![CDATA[TH]]></given-names>
</name>
<name>
<surname><![CDATA[Heerspink]]></surname>
<given-names><![CDATA[HJL]]></given-names>
</name>
<name>
<surname><![CDATA[Mann]]></surname>
<given-names><![CDATA[JFE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Chronic kidney disease and cardiovascular risk epidemiology, mechanisms, and prevention]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2013</year>
<volume>382</volume>
<page-range>339-52</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mills]]></surname>
<given-names><![CDATA[KT]]></given-names>
</name>
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Bundy]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Kelly]]></surname>
<given-names><![CDATA[TN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease from 1990 to 2010]]></article-title>
<source><![CDATA[Kidney Int]]></source>
<year>2015</year>
<volume>88</volume>
<page-range>950-7</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lynn]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Adamson]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
</person-group>
<source><![CDATA[Living well at the end of life: adapting health care to serious chronic illness in old age]]></source>
<year>2003</year>
<publisher-loc><![CDATA[Santa Monica ]]></publisher-loc>
<publisher-name><![CDATA[RAND Health]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murray]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Kendall]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Boyd]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Sheikh]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Illness trajectories and palliative care]]></article-title>
<source><![CDATA[BMJ]]></source>
<year>2005</year>
<volume>330</volume>
<page-range>1007-11</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dean]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical pharmacology considerations in pain management in patients with advanced kidney failure]]></article-title>
<source><![CDATA[Clin J Am Soc Nephrol]]></source>
<year>2019</year>
<volume>14</volume>
<page-range>917-31</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cohen]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Moss]]></surname>
<given-names><![CDATA[AH]]></given-names>
</name>
<name>
<surname><![CDATA[Weisbord]]></surname>
<given-names><![CDATA[SD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Renal palliative care]]></article-title>
<source><![CDATA[J Palliat Med]]></source>
<year>2006</year>
<volume>9</volume>
<page-range>977-92</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alonso Babarro]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[García Llana]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Leiva Santos]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez Hernández]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<source><![CDATA[Cuidados paliativos en la enfermedad renal crónica avanzada: guía de práctica clínica]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Madrid ]]></publisher-loc>
<publisher-name><![CDATA[Sociedad Española de Nefrología (SENEFRO) y Sociedad Española de Cuidados Paliativos (SECPAL)]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Freidin]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Person-centered care for older adults with kidney disease core curriculum 2019]]></article-title>
<collab>O'Hare AM.Wong SP</collab>
<source><![CDATA[Am J Kidney Dis]]></source>
<year>2019</year>
<volume>74</volume>
<page-range>491-503</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
