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Kidney Week

Abstract: TH-PO642

Palliative Care Consultation for Hospitalized Patients with Advanced CKD and Its Impact on Goals of Care

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Asif, Muhammad, University of Virginia, Charlottesville, Virginia, United States
  • Mamdouhi, Peyman, University of Virginia, Charlottesville, Virginia, United States
  • Ma, Jennie Z., University of Virginia, Charlottesville, Virginia, United States
  • Abdel-Rahman, Emaad M., University of Virginia, Charlottesville, Virginia, United States
Background

Chronic kidney disease (CKD) is a complex disease associated with high morbidity and mortality. Prognosis is even worse when these patients require hospitalization and identifying their goals of care is crucial. Palliative care (PC) is a comprehensive patient-centered approach that can help guide future care. Scarce data is available assessing frequency of PC consultation (PCC) for these patients and its impact on goals of their care. We aimed to assess frequency of PCC in hospitalized patients with advanced CKD/ESKD and its impact on advance directive (AD) and do not resuscitate (DNR) ordering.

Methods

We retrospectively studied all patients with CKD with eGFR<60 ml/min / ESKD hospitalized at UVA between 1/1/2015-6/30/2017. Number of PCC, AD and DNR orders were recorded as well as patients’ demographic and comorbidity data.

Results

8653 patients with eGFR<60 ml/min were hospitalized 13,321 times during the study period. PCC was obtained in 1274/8653 (14.7%) patients. Patient consulted for PC were significantly older, sicker, with less BMI and more advanced kidney disease (all with P<0.0001) compared with patients who did no get PCC. AD was obtained in 157/8653 (1.8%) patients. While AD was obtained in 12.1% with PCC, it was obtained in 0.04% with no PCC. DNR were signed in 2055/8653 (23.7%). While DNR was signed in 70.5% with PCC, it was signed in 15.7% with no PCC. Patients signing DNR orders were significantly older (73.0 + 13.8 vs 67.7 + 14.6), sicker (Charlson 4.6 + 3.8 vs 3.3 + 3.1) with less BMI and more advanced kidney disease (eGFR <30 ml/min 39.4% vs 27.1%). There was a trend to have more blacks signing DNR compared to whites (P =0.059)

Conclusion

PCC are underutilized in the care of hospitalized patients with advanced CKD/ESKD. PCC plays a significant role in guiding patients’ goals of care.

PCC versus No PCC
 PCC (n=1274)No PCC (n=7379)
Percentage

14.7%85.3%
Age (years)
69.9+/-14.467.0+/-14.7
Charlson score5.0 +/- 4.03.3 +/- 3.1
Sex (F)46.5%47.6%
Race (W)80.5%79.7%
BMI <25
>40
41.2%
7.0%
25.2%
9.7%
eGFR 30-60 ml/min
<30 ml/min
58.8%
41.2%
71.9%
28.1%
AD12.1%0.04%
DNR70.5%15.7%