XXXX requiring renal replacement therapy in the intensive care unit: impact on prognostic assessment for shared decision making.

@entity1 @entity221 @entity810
A 69-year-old female was receiving renal replacement therapy (RRT) for @entity810 ( @entity810 ) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care. Clinician responsibility in shared decision making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match @entity1 values with treatment options. For this @entity1 , @entity810 requiring RRT in the ICU was used as a focal point for preparing a prognostic assessment. A prognostic assessment should include the outcomes of most importance to a discussion of goals of care: mortality risk and survivor functional status, in this case including renal recovery. A systematic review of the literature was conducted to document published data regarding these outcomes for adult @entity1 receiving RRT for @entity810 in the ICU. Forty-one studies met the inclusion criteria. The combined mean values for short-term mortality, long-term mortality, renal-function recovery of short-term survivors, and renal-function recovery of long-term survivors were 51.7%, 68.6%, 82.0%, and 88.4%, respectively. This case example illustrates a process for formulating and expressing a prognostic assessment for an ICU @entity1 requiring RRT for @entity810 . Data from the literature review provide baseline information that requires adjustment to reflect specific @entity1 circumstances. The nature of the acute primary process, comorbidities, and severity of @entity221 are key modifiers. Finally, the prognostic assessment is expressed during a family meeting using recommended principles of communication.
