We treated a dementia patient with end stage chronic kidney disease (CKD). The patient also had severe chronic heart disease and suffered from untreatable respiratory distress during the clinical course of his illness. We therefore initiated peritoneal dialysis therapy (PD) as renal replacement therapy, although we had difficulties continuing stable PD for many reasons, including a burden on caregivers and complications associated with PD therapy itself. Under these circumstances we considered that palliative care prior to intensive care may have been an optional treatment. This was a distressing decision regarding end-of-life care for this patient. We were unable to confirm the patient’s preference for end-of-life care due to his dementia. Following sufficiently informed consent the patient’s family accepted withdrawal from dialysis (WD). We simultaneously initiated nonabandonment and continuation of careful follow-up including palliative care. We concluded that the end-of-life care we provided would contribute to a peaceful and dignified death of the patient. Although intensive care based on assessment of disease is important, there is a limitation to care, and therefore we consider that WD and palliative care are acceptable options for care of our patients in the terminal phase of their lives. 1. Introduction Recently, the number of elderly dialysis patients has been increasing in Japan. According to the statistical data, nearly 60% of maintenance dialysis patients are currently over 65 years old [1]. A survey has reported that the annual mortality rate of patients on dialysis in Japan is approximately 10% [2]. In addition, the majority of dialysis patients die in a hospital [3]. Current end-of-life care for these patients has not been sufficiently discussed despite their high mortality rate [4]. The aim of this report was to explore methods for better management of end-of life care including WD and palliative care for dialysis patients with comorbid conditions and dominant illnesses admitted to a municipal hospital. Furthermore, the report has the objective of encouraging nephrologists to develop an interest in the better management of end-of-life care for maintenance dialysis patients. Withdrawal from dialysis (WD) in end-of-life care for patients has been reported in several studies [5–9]. The benefit of dialysis is that it is a life-sustaining therapy; however it may sometimes be burdensome for patients in the terminal phase. Palliative care is also worth considering simultaneously with WD [10, 11]. Immediately after WD, due to accumulation of
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