| [ Summary ] |
Approximately 30,000 maintenance dialysis patients die every year. The 2011 death toll was 28,768 and the top 3 causes of death were cardiac failure (26.7 %), infection (20.3 %) and malignant tumors (9.1 %). There is no data concerning withholding or withdrawal of care for dialysis in Japan. However, the number of patients dying due to 'suicide or refusal' is reported to be 0.7 %. Because the causes of death are so varied, the methods for terminal care must also be diverse. After initiation of dialysis and when stability has been achieved, return to a somewhat normal life may be realized. However, complications may arise which cannot be completely avoided. In time, the basic functions of daily life become difficult or impossible. Terminal care should be started at this time. A most troubling situation for physicians is when the intentions of the terminally ill patient are unknown. Advance directives are highly necessary and recommended. Their creation should be discussed with the patient when their condition is stable after having begun dialysis. Decisions for the introduction of dialysis do not depend on the level of renal dysfunction alone. Medical staffs, patients and family members must take into consideration the overall condition of the patient when deciding on the effectiveness of dialysis therapy. |