Abstract: TH-PO649
Retrospective Cohort Study of Patients Seen in a Specialized Renal Supportive Care Clinic
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
- Bursic, Alexandra E., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Schell, Jane O., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Bansal, Amar, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
Background
Palliative care is underutilized in advanced kidney disease care despite similar mortality and symptom burden as other life-limiting illnesses. Patients are less likely to engage in advance care planning (ACP) and often begin dialysis without an informed conversation about conservative care. As a result, patients with advanced renal disease are more likely to receive invasive, burdensome treatments at the end of life compared to those with other serious illnesses. We describe outcomes of a Renal Supportive Care Clinic (RSCC) at UPMC, staffed by dually trained nephrology and palliative medicine physicians.
Methods
We reviewed the medical records of all patients seen in RSCC during 2015, with follow-up through February 2019. We recorded documentation of ACP and whether patients had chosen a conservative care (CC) pathway without dialysis. Additional data collected included demographics, comorbid conditions, date that eGFR fell below 20 mL/min/1.72m2, and death date (when available).
Results
A total of 48 patients were seen in RSCC in 2015. Mean age at first visit was 74 (± 8.7) years. Over half (60%) were female, and 14 (29%) were Black. Eight (17%) were receiving dialysis at the time of RSCC visit. Mean creatinine at presentation was 2.4 (± 1.5) mg/dL (excluding dialysis patients). ACP was performed with 43 patients (90%), and a surrogate decision maker was documented for 41 (85%). Seventeen patients (35%) had a documented goals of care conversation indicating a CC pathway. Of these patients, only 2 (12%) started dialysis. Among the 15 patients who remained on CC, 9 survived until the end of the study period. Six of these patients had an eGFR that never fell below 20. Of the remaining three patients, an average of 1500 (± 283) days elapsed between eGFR <20 and the end of the study period. Of the patients who died, mean length of time between eGFR <20 and death was 376 days (± 340).
Conclusion
Advance care planning conversations occurred frequently in RSCC, and a significant minority of patients chose conservative care without dialysis. Of CC patients, a majority survived the 4-year follow-up period (including several with eGFR<20). Among patients who died, mean survival after eGFR fell below 20 was greater than 1 year. Further research is necessary to determine how palliative care can be efficiently integrated into care delivery for advanced kidney disease.