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Kidney Week

Abstract: FR-PO450

A Nationwide Survey of Conservative Kidney Management in Japan

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sakai, Ken, Toho Daigaku, Ota-ku, Tokyo, Japan
  • Okada, Hirokazu, Saitama Daigaku, Saitama, Japan
  • Kashihara, Naoki, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
Background

Even with our best possible efforts, death is an inevitable endpoint. The age of entering dialysis has reached over 70 years/old in Japan. Withhold and withdrawal dialysis have emerged problem in elderly society. This article explains the selection and current situation of conservative kidney management (CKM) based on nationwide survey in Japan.

Methods

Quetionnaire responses were collected in 2020, based on the 2-year period status from 2018 to 2019. A web-based questionnaire was sent to all members of 4 societies (Japanese Society of Nephrology, Society for Dialysis Therapy, Association for Home Care Medicine, and Society for Pediatric Nephrology), and one response was received from each facility to avoid duplication of cases. Thus, although the exact response rate could not be counted, responses were obtained from 451 facilities.

Results

Among the responses, 299 were from hospitals, 104 were from dialysis clinics, and 37 were from visiting physicians. In the past 2 years (2018-2019), the number of patients who opted for withholding of dialysis was 917, and that for withdrawal from dialysis was 492 (1409 in total). In patients who were 80 years or older, the increase in the number of patients who opted for withholding of dialysis was substantial, with more than twice as many patients than those who opted for withdrawing from dialysis. Among patients who withheld or withdrew from dialysis, the number of patients with poor cognitive function was approximately twice that of those with good, and poor cognitive function was prominent in patients who withheld dialysis. In terms of prognosis after withholding or withdrawal of dialysis, many patients died 1 month after withholding of dialysis and 7-14 days after withdrawal from dialysis. The contents of palliative care varied but pain management was a main component: not many patients were transferred to the palliative ward or home. Relevant confirmation document were obtained, but the explanation of CKM as a therapy option was provided at the time of therapy selection in just 40% of cases.

Conclusion

CKM is not yet as well recognized as renal replacement therapy, and thus, deliberation is still required for consensus-building on CKM, as well as on ACP. Adequate time must be also spent for full SDM in the elderly Japanese dialysis population.

Funding

  • Government Support – Non-U.S.