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
| Outcomes | Terminal (N = 30) |
| Palliative care consultation | 14 (47%) |
| Opiate use | 25 (83%) |
| Cardiopulmonary resuscitation | 5 (17%) |
| Mechanical ventilation | 11 (37%) |
| Tube feeds | 5 (17%) |
| Vasopressor therapy | 10 (33%) |
| Hospice referral | 8 (27%) |
| Place of death | |
| Inpatient ward | 7 (23%) |
| Intensive care unit | 13 (43%) |
| Inpatient hospice | 4 (13%) |
| Unknown | 6 (20%) |