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Case Reports in Nephrology
Volume 2013, Article ID 761691, 4 pages
http://dx.doi.org/10.1155/2013/761691
Case Report

Withdrawal from Dialysis and Palliative Care for Severely Ill Dialysis Patients in terms of Patient-Centered Medicine

1Department of Nephrology and Palliative Care, Tokai Central Hospital, Japan Mutual Aid Association of Public School Teachers, 4-6-2 Sohara-Higashijima-cho, Kakamigahara, Gifu 504-8601, Japan
2Tokai Central Hospital, 4-6-2 Sohara-Higashijima-cho, Kakamigahara 504-8601, Japan

Received 9 October 2013; Accepted 5 November 2013

Academic Editors: J. Almirall, M. Karim, and A. Shoker

Copyright © 2013 Hideaki Ishikawa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We treated a dementia patient with end stage chronic kidney disease (CKD). The patient also had severe chronic heart disease and suffered from untreatable respiratory distress during the clinical course of his illness. We therefore initiated peritoneal dialysis therapy (PD) as renal replacement therapy, although we had difficulties continuing stable PD for many reasons, including a burden on caregivers and complications associated with PD therapy itself. Under these circumstances we considered that palliative care prior to intensive care may have been an optional treatment. This was a distressing decision regarding end-of-life care for this patient. We were unable to confirm the patient’s preference for end-of-life care due to his dementia. Following sufficiently informed consent the patient’s family accepted withdrawal from dialysis (WD). We simultaneously initiated nonabandonment and continuation of careful follow-up including palliative care. We concluded that the end-of-life care we provided would contribute to a peaceful and dignified death of the patient. Although intensive care based on assessment of disease is important, there is a limitation to care, and therefore we consider that WD and palliative care are acceptable options for care of our patients in the terminal phase of their lives.