| Theme |
Cognitive impairment and dialysis therapy |
| Title |
Issues regarding regular dialysis initiation for ESRD patients with severe dementia |
| Author |
Masaaki Nakayama |
Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University |
| Author |
Shuhei Watanabe |
Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University |
| [ Summary ] |
Cognitive impairment is one of the treatable clinical presentations among elderly patients with chronic kidney disease. Therefore, upon dialysis initiation, physicians need to take this clinical point into consideration for cases with dementia. The JSDT recommends facilitating the decision process regarding dialysis application by shared decision-making among the medical team and the patients' family or persons in charge if needed, in which patients with severe dementia should be considered. However, the meaning of "life-worth-living" is not uniform, and therefore, it is not easy to decide when not to initiate dialysis. In the future, we need to establish a comprehensive support system that could provide medical, nursing, and psychiatric care to patients and family members. |