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Woman who died after halting dialysis never offered alternative treatment method

Fussa Hospital is seen in Fussa, Tokyo, in this March 6, 2019 photo. (Mainichi/Yuki Miyatake)

TOKYO -- A surgeon at a hospital here failed to offer peritoneal dialysis to a woman with a kidney ailment who died after choosing to discontinue regular dialysis treatment, relatives said.

The 50-year-old surgeon at Fussa Hospital in the western Tokyo city of Fussa only offered a choice between continuing or discontinuing regular hemodialysis to the woman, who died at age 44 about a week after stopping the treatments.

There are two types of dialysis. One is hemodialysis, in which a needle is inserted into a patient's arm or a catheter into an area around the neck, and the patient's blood is run through a tube to a dialysis machine for purification and flowed back through another tube. The second type is peritoneal dialysis, in which a cleansing fluid, or dialysate, is circulated through a tube inside the abdominal cavity. The fluid extracts waste products from the blood running through vessels in the peritoneum -- the membrane that lines the inside of the abdomen -- before it is drawn back out of the body and disposed of.

The woman visited Fussa Hospital on Aug. 9 last year after hemodialysis through her arm became problematic. During an examination, the surgeon offered her a choice between the catheter inserted in the neck area and discontinuing dialysis altogether. The doctor told her that stopping dialysis would directly lead to her death.

The woman's 51-year-old husband, who accompanied her, said the surgeon did not mention peritoneal dialysis. He added that the 55-year-old kidney specialist who met the woman the following day also did not offer peritoneal dialysis as an option.

Since peritoneal dialysis requires the insertion of a tube through the abdominal wall, the treatment method can only be used for up to about 10 years, say experts. However, there is no needle involved and the dialysate only needs to be replaced one to four times a day, giving the patients greater freedom.

The Health, Labor and Welfare Ministry underscores the need to promote adoption of peritoneal dialysis and kidney transplants, which it says are more widespread in other countries. Patients that are being treated with hemodialysis can switch to peritoneal dialysis and vice versa, according to the Japan Society for Dialysis Therapy.

The surgeon and kidney specialist at Fussa Hospital admitted that peritoneal dialysis was possible for the woman. However, the doctors said they chose not to offer her peritoneal dialysis after deeming it extremely difficult. They explained there would be problems with purifying her blood just several months after beginning the therapy, considering her condition.

The 28-year-old son of the woman said she did not like dialysis because of pain from the needle insertion.

"My mother said she wanted to undergo dialysis if it wasn't painful," he recalled.

Yuzo Watanabe, director of Kasugai Municipal Hospital in the central Japan prefecture of Aichi and an expert in dialysis therapy, pointed out that the physicians' failure to offer peritoneal dialysis was inappropriate.

"Since all the available options were not presented, the patient was deprived of her right to treatment," he said.

The woman's bereaved family said she had attempted suicide three times since developing neurotic depression symptoms in 1999. The surgeon admitted in an interview with the Mainichi Shimbun that he was unaware of that.

(Japanese original by Yoshihiko Saito and Masashi Taguchi, Lifestyle News Department)

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