Bedridden Hemodialysis Patient Requiring Mechanical Ventilation Successfully Transited to Home Care by Switching to Peritoneal Dialysis： A Case Report

Abstract

To provide medical care that complements patients’ preferred lifestyles, flexible approaches are required even for those with end‒stage kidney disease (ESKD) complicated by multiple comorbidities. Here, we present the case of a bedridden hemodialysis (HD) patient who wanted to transition from hospital to home. The patient, who had neuromuscular disease requiring mechanical ventilation, successfully received 10‒month home care by switching to peritoneal dialysis (PD). Specifically, the patient was a 35‒year‒old man with ESKD due to IgA nephropathy, who had been diagnosed with myasthenia gravis six years ago. His condition gradually worsened, resulting in a ventilator‒dependent bedridden state and enteral tube feeding requirements. One year ago, he was transferred to a long‒term care hospital. Subsequently, suicidal ideations developed, and both he and his family expressed a strong desire for home care. PD was therefore introduced as an alternative renal replacement therapy. The patient’s family received comprehensive training in PD, as well as ventilator and enteral feeding procedures. Home visits by physicians, visiting nurses, and home helpers were arranged, and the patient was discharged home. Although the burden on the family was marked, no complications related to PD or ventilator use occurred. However, owing to the development of general fatigue, the patient resumed HD 10 months after discharge. In Japan, support systems for patients with PD who require care are insufficient. Thus, medical and social support for such patients requiring home care must be improved on an individual basis to reduce the burden.