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Kidney Week

Abstract: SA-PO540

Temporal Trend of Utilization of Palliative Care Encounters in Hospitalized Patients with Dialysis Requiring AKI - A Nationwide Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Wen, Yumeng, Mount Sinai St Luke's and Mount Sinai West, New York, New York, United States
  • Hernandez Cuchillas, Marcelo Xavier, Mount Sinai St Luke's and Mount Sinai West, New York, New York, United States
  • Jiang, Changchuan, Mount Sinai St Luke's and Mount Sinai West, New York, New York, United States
  • Mariuma, David, Mount Sinai St Luke's and Mount Sinai West, New York, New York, United States
  • Pan, Di, Mount Sinai St Luke's and Mount Sinai West, New York, New York, United States
Background

Dialysis requiring AKI (AKID) is major cause of in-hospital morbidity and carries high rate of mortality. We sought to investigate the temporal trend of the utilization of palliative care (PC) in hospitalized patients with AKID in United States.

Methods

We conducted a retrospective study using the national inpatient sample from 2005 to 2014, to identify hospitalized patients complicated by AKID. The outcomes were the temporal trend and factors associated with utilization of PC in hospital. Multivariate logistic analysis was conducted to calculate odds ratios, adjusting for demographics, hospital characteristics, comorbidities and code status. Analysis was performed using Stata 14.0.

Results

A cohort of 808,159 patients was identified from 2005 to 2014, of whom 5.88% had palliative care consult referral. The incidence of palliative care contact increased from 0.41% in 2005 to 12.38% in 2014 (aOR 1.18, p<0.01). Patients who received palliative care contact, compared to who did not, were older (65.37 vs 62.50, p<0.01) and more likely to die in hospital (75.00% vs. 25.62%, p<0.01). Factors associated with more frequent PC referral included more cormobidities, Caucasian race (compared to other minorities), teaching hospitals, larger hospitals, hospitals region other than Northeastern area, Medicaid insurance and do not resuscitate status (shown in Table 1).

Conclusion

The use of palliative care consultation for patients with AKID who are admitted to hospitals, based on the NIS, is approximately 5.88%. Race, insurance status, hospital size, location and teaching status all were associated with differential rates of referral. There was a significant increase in palliative care use observed from 2005 to 2014.