Abstract: FR-PO1162
End-of-Life Care in Young Dialysis Patients
Session Information
- Pediatric Nephrology - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1600 Pediatric Nephrology
Authors
- Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
- Sexton, Donal J., The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin., Dublin, Ireland
- Reule, Scott, VA, Minneapolis, Minnesota, United States
Background
Although end-stage kidney disease in the young is often a progressive disorder with high mortality, end-of-life care in this population has not been well characterized. In particular, it is unknown whether end-of-life care has changed over time and whether racial and ethnic disparities are present.
Methods
We used United States Renal Data System files to examine these issues among patients dying on maintenance dialysis in the US at age 0-20 years, between 2000 and 2014 (N=1647).
Results
While the proportions that discontinued dialysis were similar in 2000-2006 and 2007-2014 (14.8% Vs. 17.9, P-Value 0.09), the proportions receiving hospice care (3.6% Vs. 12.8%, P-Value <0.001) and dying outside of hospital (25.1% Vs. 33.8%, P-Value <0.001) both rose. Dialysis discontinuation (20.6% in white Vs. 10.4% in African American, P-Value <0.001), hospice care (11.1% in white Vs. 3.9% in African American, P-Value <0.001) and non-hospital death (35.6% in white Vs. 23.7% in African American, P-Value <0.001) were less likely in decadents from minority populations than in those of non-Hispanic white race-ethnicity. Findings regarding temporal trends and racial disparities were similar when adjustment was made for age, sex, and race/ethnicity.
Conclusion
While end of life care has changed substantially over time, discontinuation of dialysis, hospice care and death outside of hospital remain exceptional in young patients dying on maintenance dialysis. In addition, substantial racial and ethnic disparities are present.