Abstract: SA-PO438

End-of-Life Care in Advanced Kidney Disease Treated and Not Treated with Maintenance Dialysis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Wong, Susan P.Y., VA Puget Sound Health Care System, HSR&D, Seattle, Washington, United States
  • Yu, Margaret K., Stanford Univerity, Stanford, California, United States
  • Liu, Chuan-fen, VA Puget Sound Health Care System, HSR&D, Seattle, Washington, United States
  • Hebert, Paul L., VA HSR&D Puget Sound Healthcare System, Seattle, Washington, United States
  • O'Hare, Ann M., VA Puget Sound Health Care System, HSR&D, Seattle, Washington, United States
Background

Little is known about the clinical course of patients with chronic kidney disease (CKD) who do not receive maintenance dialysis.

Methods

We followed a national cohort of 28,568 patients receiving care in the US Department of Veterans Affairs (VA) from the date of their second estimated glomerular filtration rate <15 ml/min per 1.73m2 occurring between 2000-2009 through October 1, 2011. We used a combination of national registry data on dialysis, VA and Medicare files, and medical record review to identify a subset of 18,051 patients who were treated with dialysis, 851 patients in whom there was a decision not to pursue dialysis, and 640 patients who were preparing for but had not started dialysis during follow-up. We compared survival, hospitalization and receipt of an intensive procedure during the final month of life, in-hospital death, palliative care consultation and hospice enrollment during follow-up across treatment groups.

Results

Median survival was 47.4 months for patients who received dialysis, 6.3 months for those who did not pursue dialysis (HR 2.17, 95% CI 2.94-3.42) and 10.7 months for those who were preparing for dialysis (HR 2.39, 95% CI 2.19-2.62). Hospitalization (57.3% vs. 76.8%; OR 0.40, 95% CI 0.34-0.46), receipt of an intensive procedure (3.5% vs. 24.6%; OR 0.15, 95% CI 0.10-0.22) and in-hospital death (41.4% vs. 57.3%; OR 0.78, 95% CI 0.74-0.82) were less common and palliative care consultation (52.6% vs. 21.6%; OR 4.19, 95% CI 3.58-4.90) and hospice enrollment (38.7% vs. 18.2%; OR 3.32, 95% CI 2.83-3.89) more common among patients who did not pursue dialysis than in those who received dialysis. For patients who were preparing for dialysis, hospitalization, receipt of an intensive procedure, and in-hospital death were less common but palliative care consultation and hospice referral similar as compared with patients treated with dialysis.

Conclusion

Patients with advanced CKD not treated with dialysis had more limited survival and received less intensive end-of-life care than those treated with dialysis.

Funding

  • NIDDK Support