Abstract
The most common cause of death in Japanese dialysis patients is heart failure. It is becoming more important to treat terminal dialysis patients with end-stage heart failure as the number of elderly patients with severe diabetic or non-diabetic complications increases. However, there are no guidelines, especially regarding withdrawal from dialysis, for terminal dialysis patients. We report a 69-year-old man with “end-of-life” heart failure caused by hypertrophic cardiomyopathy. He needed comprehensive palliative care in cooperation with a palliative care physician, a cardiologist, dentists, pharmaceutists, nursing staff and dietitians. The medical and ethical application of anxiolytic medication, withdrawal from dialysis, turning the defibrillator off and sedation had been discussed. We could not use some drugs, including hydromorphone, because of renal failure. Also, the explanation of dialysis withdrawal for the patient and his family was difficult. These problems are unique to dialysis patients. The number of such severely complicated patients has been predicted to increase as medical technology progresses. We report this case to show the necessity of formulating some guidelines for terminal dialysis patients in the future.
