| [ Summary ] |
There has been an increase in the number of elderly patients with chronic kidney disease due to the aging of the general population. As a result, the number of judgments concerning initiation or withholding of dialysis for very elderly patients with end-stage kidney disease, who are not expected to return to self-sustainable states, has become more common. Concomitant medical problems such as low activity levels, dementia, and poor life expectancy cause care givers to hesitate to initiate dialysis in those patients. In addition, the burdens placed on patients' families, medical staffs, and resultant socioeconomic adversity should be considered before the initiation of dialysis. In other countries, the criteria and guidelines for withholding dialysis are created and recommended, whereas they have not been developed in Japan. This has resulted in an increase in the number of the very elderly dialysis patients who are not self-sustaining. The increased medical care has emerged as a social problem. It is necessary for us to begin to grapple with this problem as soon as possible for the sake of our nation. |