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Kidney Week

Abstract: TH-PO670

Geriatric Nephrology Patients Deteriorating and Dying in Acute Care: How Do They Die?

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

  • Bendall, Anna, St Vincents Melbourne, Melbourne, New South Wales, Australia
  • Harris, Georgia, The University of Melbourne, Melbourne, Victoria, Australia
  • Weil, Jennifer Louise, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  • Scott, Caroline Laura, St Vincent''s Hospital Melbourne, Heidelberg, New South Wales, Australia
  • Marco, David, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  • Ducharlet, Kathryn, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
Background

Older patients with advanced kidney disease have complex medical and psychosocial needs, and providing comprehensive end of life care (EOLC) within acute healthcare settings is a challenge increasingly encountered by nephrologists. Data relating to the practice of EOLC within the inpatient nephrology setting is required to better inform and improve service provision. This study aims to review current care practices for deteriorating and dying patients admitted to the nephrology unit at St Vincent’s Hospital Melbourne (SVHM), Australia.

Methods

Retrospective cohort study of patients aged >60years who died while admitted to the Nephrology unit at SVHM between 1/1/2013 and 31/12/2018.

Results

During the study period, 56 patients died while admitted to the Nephrology unit (average age 73years), and 84% were receiving long term dialysis (55% haemodialysis, 29% peritoneal dialysis). The average length of admission was 13 days, and patients had more than 2 admission in their final year of life.

On average four invasive interventions were performed in the final 48 hours of life, including dialysis, intubation, parenteral feeding, intravenous fluids or antibiotics. Patients were admitted to the intensive care unit (ICU) in 42% of cases, and one third (32%) died in the ICU.

At the time of admission only two patients had a formal advance care directive in place. During the admission, on the majority of occasions (75%) a documented discussion regarding goals of care (GOC) was held between a physician and the patient or caregiver, on average 3 days prior to death. Consultation by palliative care services occurred on one third (33%) of occasions, and in the final 24 hours an average of two uncontrolled symptoms were documented for each patient, including pain (52%), dyspnoea (41%), drowsiness (32%), and nausea (23%).

Conclusion

The majority of geriatric nephrology patients who died in the acute setting were receiving long term dialysis, and had a high burden of uncontrolled symptoms. One third of these deaths occurred in the ICU, and very few had advance care directives. This study illustrates opportunities for the clinician to improve care for older renal patients through earlier recognition of the dying patient, enhanced communication during EOLC planning, and greater emphasis on symptom control.