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KMID : 0359920080270010085
Korean Journal of Nephrology
2008 Volume.27 No. 1 p.85 ~ p.93
Application of Advance Directives for Patients with End Stage Renal Disease
Nam Yang-Hoon

Oh Ji-Min
Choi Jin-Ho
Yoon Sung-Min
Choi Jun-Hyouck
Lim Ji-Hwan
Yoon Su-Jin
Seo In-Seok
Kim Jang-Eon
Kwon Kyu-Heum
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.

Conclusions: 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.
KEYWORD
Advance directives, Hemodialysis, End stage renal disease
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