Happiness is one of the great challenges and privileges that the human being can experience in step and over earthly universe. There is no doubt that many humans have lived many unique experiences, positive and satisfying. On the other hand some more than others have felt firsthand the suffering and desolation frustration that led part of their existence. But the challenge of living a productive and positive is one of the great challenges of every human being, despite the obstacles that life brings us. By living longer but much more than our ancestors accompanies aging, chronic diseases such as diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic kidney disease (CKD) and others that can accelerate our premature death. One of the chronic diseases that are ravaging the Puerto Rican population is diabetes mellitus. Nearly half of people with diabetes will develop some form of kidney damage. What we know using a new classification of CKD. This classification identifies what stage of renal function is the person. It can range from normal, mild, moderate and permanent kidney damage. In the severe stage known as V and permanent kidney disease (ERP), with the acronym in English ESRD, the kidneys stop working and you can not get the balance between good and toxic substances in our body. This stage accumulates toxic substances and establishing the state of toxicity that may eventually kill sick people by this condition. However, dialysis is an option but not for everyone. At the end is a personal decision of the individual, their doctor and possibly their families or significant others. In view of the decision which is the best option to follow list the following:

1. Do nothing and wait for death without any help.
2. Say OK to dialysis, knowing the advantages and disadvantages.
3. Say OK to kidney transplant if the person is a candidate.
4. Not accepting dialysis or kidney transplantation and select, conservative treatment with the help of a multidisciplinary team

Because of the importance of this decision has designed an integrated multidisciplinary has the following components.

1. Is initially evaluated the cognitive, functional impairment, and fragility of the person.
2. He converses with patient goals, plan of life and in turn explores the knowledge of the person on their health and life expectancy.
3. Educates the patient about the impact of dialysis in their mental and physical function. Also as this treatment affects their daily activities and therefore their quality of life.
4. It tells the person the prognosis of your condition with or without dialysis.
5. You have treatment options; dialysis center or at home, and if kidney transplant candidate for conservative management without dialysis.
6. After that process and confirm that the patient understands grounds establishing a plan of action.
7. Based on the above mentioned treatment plan is completed advance directives.

Adapted from: An Integrative Approach to Advanced Kidney Disease in the Elderly: Advances in Chronic Kidney Disease, Vol 17, No 4 (July 2010) Now is the time to start dialogue on patients living with severe renal disease and require dialysis. Accept that life expectancy decreases greatly especially in people who reach this stage over 65 years old and suffering from this condition. Happiness is taking action in full knowledge of its impact on our lives, colored with our values, our life expectancy and quality of it.

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By Dr. Rafael Burgos Calderón,  Medical Director for Atlantis and PR Renal Health & Research Inc.