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Kidney Week

Abstract: SA-PO747

Palliative Care Use and Patterns of End-of-Life Care in Hospitalized Patients with Calciphylaxis

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Olaniran, Kabir O., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Percy, Shananssa, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Eneanya, Nwamaka D., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Calciphylaxis (CUA) is a rare debilitating condition that is associated with poor quality of life and significant morbidity and mortality. Given that palliative care referrals are scarce in this population, we investigated the frequency of palliative care referrals and patterns of end-of-life (EOL) care in hospitalized CUA patients.

Methods

We included patients with CUA (confirmed by skin biopsy or clinical diagnosis via chart review) who were admitted to a large health care system in Boston, MA and died between 1/2014-4/2018. Terminal admissions were identified by chart review and outcomes included palliative care consultation, opiate use, receipt of cardiopulmonary resuscitation, mechanical ventilation, tube feeds, and vasopressor therapy, hospice referral, and place of death.

Results

Thirty CUA patients were identified. Seven percent had chronic kidney disease and 87% received dialysis. The median age at diagnosis was 60(15) years, 53% were female and 80% were White. The median Charlson Comorbidity Index score was 6(3) and median follow-up time was 63(104) days. Outcomes are displayed in Table 1.

Conclusion

Among CUA patients that died during the study period, less than half received palliative care consults and many patients received intense care prior to death. Furthermore, a minority of patients were referred for hospice care prior to death. Our data highlights the need for improved integration of palliative care to decrease care intensity and improve quality of EOL care for this seriously ill patient population.

Outcomes in Terminal Admissions
OutcomesTerminal (N = 30)
Palliative care consultation14 (47%)
Opiate use25 (83%)
Cardiopulmonary resuscitation5 (17%)
Mechanical ventilation11 (37%)
Tube feeds5 (17%)
Vasopressor therapy10 (33%)
Hospice referral8 (27%)
Place of death 
Inpatient ward7 (23%)
Intensive care unit13 (43%)
Inpatient hospice4 (13%)
Unknown6 (20%)