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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Patients decline dialysis for varied personal, cultural, and health-system reasons that differ by economic context. This systematic review and qualitative meta-synthesis aimed to identify and compare determinants of dialysis refusal among adults with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD) in high-income countries (HICs) and low-/middle-income countries (LMICs), to inform patient-centred, equitable renal care.
Following a pre-specified protocol registered in PROSPERO (CRD420251139680), we included studies of adults (≥18 years) with advanced CKD/ESRD who refused, deferred, or chose conservative management instead of initiating dialysis and that reported patient perspectives. Searches were run in MEDLINE, Embase, CINAHL, Scopus, and Web of Science (2000–2025), supplemented by grey literature and reference lists to ensure comprehensive retrieval of qualitative evidence. One reviewer screened and extracted data; a second reviewer verified all decisions. Risk of bias was assessed with CASP for qualitative studies and Newcastle–Ottawa Scale or AXIS for quantitative studies. Data were synthesised using thematic analysis with inductive coding and descriptive comparison by country income level.
Seventeen studies met inclusion criteria (predominantly qualitative; sample sizes 5–152; participants aged ~47–85). Six overarching themes explained refusal: (1) fear (needles, complications, death); (2) cultural/spiritual beliefs (preference for alternative healing, framing of natural death); (3) family and social influences (perceived burden, support or pressure); (4) economic and resource barriers (cost, transport, facility scarcity); (5) quality-of-life and treatment-burden concerns (loss of independence, lifestyle disruption); and (6) communication and decision-making factors (dialysis presented as default, limited discussion of conservative care). In HICs, refusal commonly reflected a deliberate, value-based choice prioritising autonomy and quality of life. In LMICs, refusal was more often a constrained necessity driven by financial hardship and limited access. Fear, family influence, and cultural meanings of illness were recurrent across settings.
Dialysis refusal manifests as a value-driven choice in resource-rich settings and as a structural constraint in resource-limited settings. To support informed, equitable decisions, clinicians and systems should strengthen shared decision-making, improve culturally competent education about options including conservative care, and address financial and access barriers.
