Debra Hain

The number of African American adults 65 years and older with end-stage kidney disease receiving maintenance hemodialysis is increasing. The high symptom burden (ie, pain, fatigue, depression) can make it challenging for many to continue dialysis, which can lead to request to withdraw from dialysis. This can present ethical challenges when someone has diminished decision-making capacity and no advance directives or family to assist with this complex decision. This article will provide a brief overview of ethical issues to consider when responding to an older adult's request to withdraw from a life-sustaining treatment such as dialysis. Suggestions for research to address the gaps in knowledge will be presented.

There is a critical need to discover health-promoting strategies to address a growing Hispanic immigrant adult population with diabetes who are at risk or have chronic kidney disease. Fellows are uniquely positioned to lead research efforts focused on community outreach to recruit this population to a kidney health clinic. Innovative models of care are important to provide care to a population who may not seek medical attention. The author collaborated with a registered renal dietician to develop a kidney health clinic. Funding from the American Nephrology Nurses Association enabled a feasibility study to recruit patients and test the effects of a model of care on patient related and health care system outcomes.