ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1696

Symptoms and Suffering at the End of Life in ICU Patients Receiving Dialysis

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Ramer, Sarah, Weill Cornell Medicine, New York, New York, United States
  • Viola, Martin, Weill Cornell Medicine, New York, New York, United States
  • Prigerson, Holly G., Weill Cornell Medicine, New York, New York, United States
Background

Patients with end-stage kidney disease (ESKD) on dialysis suffer from a significant burden of physical symptoms. Little is known, however, about the symptoms that intensive care unit (ICU) patients receiving dialysis experience at the end of life.

Methods

This is a cohort study conducted at NewYork-Presbyterian Hospital / Weill Cornell Medical Center and Brigham and Women’s Hospital from September 2015 to March 2017. Nurses who cared for deceased ICU patients were interviewed within 3 weeks of the deaths about patients’ physical and psychological symptoms in their last week of life. On a 1-10 scale, nurses rated 16 different symptoms on how much they contributed to a patient’s suffering and rated the patient’s overall suffering in the last week of life. Study staff abstracted demographic and clinical data from patient charts.

Results

One-hundred nurses completed interviews on 200 deceased patients, 67 of whom underwent dialysis in the last week of life (for ESKD or acute kidney injury). Mean dialysis patient age was 63 years; 39% were female; 32% were non-white; 12% were Hispanic. The nurses rated patients who underwent dialysis in the last week of life as having significantly more suffering from painful, broken skin than non-dialysis patients (mean 4.6 vs. 3.5 out of 10, P=0.045) but significantly less suffering from hunger (mean 2.4 vs. 3.6 out of 10, P=0.012) or thirst (mean 3.2 vs. 4.8 out of 10, P=0.005). There was also a trend towards more suffering from swelling in the dialysis patients (mean 6.2 vs. 5.3 out of 10, P=0.083). An unadjusted linear regression model revealed that receipt of dialysis in the last week of life was significantly associated with perceived overall suffering (β=1.35, P=0.006); however, after adjustment for painful, broken skin (β=0.19, P=0.013) and swelling (β=0.20, P=0.007) in the model, the relationship between dialysis and overall suffering was attenuated (β=0.84, P=0.074).

Conclusion

Nurses rated ICU patients who received dialysis in the last week of life as suffering from more painful, broken skin but less hunger or thirst than non-dialysis patients. The relationship between dialysis and perceived overall suffering was attenuated by painful, broken skin and swelling, suggesting that attention to these problems might reduce suffering at the end of life in ICU dialysis patients.

Funding

  • Other NIH Support