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Abstract: FR-PO837

End-of-Life Care Among Patients with ESRD Who Undergo a Lower Extremity Amputation

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Butler, Catherine, University of Washington, Seattle, Washington, United States
  • Hailpern, Susan M., University of Washington, Kidney Research Institute (retired), Seattle, Washington, United States
  • Schwarze, Margaret, UW School of Medicine and Public Health, Madison, Wisconsin, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Kurella Tamura, Manjula, Stanford University, Palo Alto, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Palo Alto, California, United States
  • Hall, Yoshio N., University of Washington-Kidney Research Institute, Seattle, Washington, United States
  • Kreuter, William, University of Washington, Seattle, Washington, United States
  • O'Hare, Ann M., VA Puget Sound Health Care System, Seattle, Washington, United States
Background

Patients with ESRD have a high incidence of lower extremity amputation and limited post-operative long-term survival, but little is known about the relationship between amputation and patterns of their end-of-life care.

Methods

We used Medicare claims to compare patterns of amputation and health care utilization in the last year of life among 754,762 patients with ESRD registered in the USRDS and 958,412 Medicare beneficiaries without ESRD who died between 2002 and 2014.

Results

During the last year of life, 8.2% of Medicare beneficiaries with, and 0.9% of those without ESRD underwent at least one lower extremity amputation. After adjustment for differences in patient characteristics, patients with ESRD were more likely to have undergone at least one amputation (relative risk (RR) 2.30, 95% confidence interval (CI) 2.24-2.35) and multiple amputations (RR 3.65, 95% CI 3.36-3.97) within a year of death. During their last year of life, patients with ESRD who underwent amputation were more likely to be admitted to the hospital, ICU, and/or to a SNF and less likely to be enrolled in hospice than other patients (figure). During this time, they spent a median of 58 days admitted to a hospital (vs. 35 days for patients without ESRD who underwent amputation, 29 days for patients with ESRD who did not undergo amputation, and 13 days for patients without ESRD who did not undergo amputation), 12 days admitted to an ICU (vs. 8, 9, and 5), 54 days admitted to a SNF (vs. 56, 39, and 32), and 5 days enrolled in hospice (vs. 10, 6, and 17).

Conclusion

Almost one in ten patients with ESRD undergo an amputation in the last year of life. These patients spend prolonged periods of time in acute and subacute care settings towards the end of life, but receive relatively little hospice care. These findings argue for more work to understand the end-of-life experience of these patients and suggest opportunities to improve care.

Percentage of patients admitted and median days spent in each care setting in the last year of life

Funding

  • NIDDK Support