Peritoneal Dialysis as End-of-Life Care at Our Hospital

• Published in: KOBE CITY HOSPITAL BULLETIN Vol. 62; pp. 17 - 24
• Main Authors: Osaki, Keisuke, Takata, Fu, Mishima, Natsumi, Ito, Seiji, Katsura, Kensuke, Hayashida, Marina, Horikawa, Seinosuke, Yoshimoto, Akihiro
• Format: Journal Article
• Language: Japanese
• Published: Kobe City Hospital Organization 2024; 地方独立行政法人 神戸市民病院機構
• Subjects: hepatorenal syndrome; home medical care; peritoneal dialysis; terminal care; 在宅医療; 終末期医療; 肝腎症候群; 腹膜透析
• ISSN: 0286-455X; 2434-7590
• DOI: 10.32301/kobecityhospital.62.0_17

[Background] The age at which dialysis is initiated in Japan is increasing, and there is a growing demand for peritoneal dialysis, particularly as a form of terminal care (referred to as " Last Peritoneal Dialysis [PD]). At our hospital, 14 cases of PD were initiated in 2022, including five cases of the Last PD. In this report, we discuss two of the five cases that we found particularly informative. Case 1 was a 73-year-old man with liver cirrhosis. After pancreatoduodenectomy, he had persistent ascites drainage (3 – 5 L/day), and his renal function worsened. We introduced PD because hemodialysis (HD) could not be performed due to frequent hypotension. The PD drainage volume, including the ascites, stabilized at 1 –2 L/day, and the patient was discharged. Case 2 was a 79 –year –old man presented with severe brain dysfunction. His wife and son took care of him. Due to end-stage renal failure, we placed a dialysis catheter and initiated HD. However, he could not maintain a lying down position during puncture and dialysis and required constant attendance by someone during dialysis. To avoid the self-extraction of the PD catheter, we created a PD catheter outlet in the left lateral abdomen and introduced a PD. [Conclusion] PD may help discharge patients who are terminally ill, have low Activities of Daily Living, or have difficulty with HD.