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Abstract: TH-PO288

Patient-Nephrologist Prognostic Awareness and Discordance in ESRD on Renal Replacement Therapy

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ghanem, Sassine, Staten Island University Hospital, Staten Island, New York, United States
  • Fuca, Nicholas, Staten Island University Hospital, Staten Island, New York, United States
  • Saouma, Samer, Staten Island University Hospital, Staten Island, New York, United States
  • Hossri, Sami U., Staten Island University Hospital, Staten Island, New York, United States
  • Forte, Frank, Staten island university hospital Nothwell Health, Staten island, New York, United States

Group or Team Name

  • SIUH Medicine/Nephrology
Background

The one-year mortality rate of patients with ESRD on renal replacement therapy is 20-25%, comparable to many cancers. Several studies have documented that patients with cancer commonly overestimate their likelihood of survival relative to their physicians however it is unclear if this translates into other terminal illnesses.

Methods

Patients with ESRD on RRT age 18 years and older with no cognitive defect were interviewed to evaluate their prognostic estimates at one and five years. Their past medical history and demographic data were abstracted from medical charts. Each patient’s nephrologist was then interviewed regarding the prognostic estimate of the patient. Both patient and nephrologist estimates were then compared and a difference of greater than 20% divided the patients into two groups, prognostic concordance or discordance.

Results

77% of the patients were found to be in prognostic discordance with their nephrologists. This group was older, had more comorbidities, a lower albumin level and a worse prognostic score. The majority of these patients were in disagreement with their nephrologists regarding whether a discussion about prognosis had occurred. The goals of care for 55% of patients was oriented towards an end of life focused on relieving pain and discomfort even if that meant a shorter duration of life.

Conclusion

Communication of prognosis and discussions related to life expectancy and planning for end of life care are lacking in routine care of ESRD patients. ESRD patients therefore tend to overestimate their prognosis, while half of the patients interviewed preferred an end of life care oriented towards symptom control, not longevity, this may lead to overutilization of invasive procedures and higher healthcare costs as well as a delay in palliative or hospice measures.