Consensus-based proposal for forgoing dialysis therapy in Japan

Abstract

AbstractThe Japanese Society for Dialysis Therapy published a proposal in 2014 and revised it to Shared Decision Making for the Initiation and Continuation of Dialysis: A Proposal from the Japanese Society for Dialysis Therapy in 2020 to strictly adhere to guidelines of the Ministry of Health, Labour and Welfare, because forgoing life-sustaining treatment to respect the will of patients in end-of-life care is not stipulated by law in Japan. The revised proposal describes the process of providing information about renal replacement therapy, the natural course of end-stage kidney disease, and conservative kidney management (CKM), the conditions when providing CKM information to be considered by healthcare teams, the process of providing information about CKM if patients with decision-making capacity or families of patients without decision-making capacity wish to make the decision to forgo dialysis, the process of shared decision making for choosing CKM, and the importance of performing advance care planning (ACP) with patients and their families for making advance directives, etc. We need to promote ACP and to establish the content and practice of palliative care for patients after choosing CKM in collaboration with home-cased care doctors.