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Kidney Week

Abstract: PO1220

Impact of a Palliative Hemodialysis on Quality Standards and Hospice Utilization

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Park, Minna, Rogosin Institute, New York, New York, United States
  • Silberzweig, Jeffrey I., Rogosin Institute, New York, New York, United States
Background

Minimal data exists regarding effect of palliative dialysis on clinical outcomes and quality measure. Frail, elderly patients may find thrice weekly, 3-5 hour hemodialysis treatments burdensome. Numerous barriers exist to providing palliative dialysis, including quality standards set by the ESRD Quality Incentive Program (QIP). This study shows the impact of reduction in dialysis frequency and time on quality standards and hospice utilization in the seriously ill elderly.

Methods

A retrospective chart review was performed on four deceased patients who received palliative dialysis in one ambulatory dialysis center. Quality standards reviewed included: dialysis adequacy (Kt/V), metabolic control, nutrition, hemoglobin and ultrafiltration rate. Clinical outcomes were also reviewed.

Results

All four patients were elderly with reduced functionality, heavy symptom burden and difficulty tolerating regular hemodialysis sessions. Patients were decreased to three hour hemodialysis sessions twice weekly. Despite decreased treatment time and frequency, most quality measures did not differ from baseline. Duration of palliative dialysis ranged from 2-11 weeks. Most patients tolerated palliative dialysis, remained free of hospitalization, successfully transitioned to hospice and did not experience serious clinical issues.
Lack of negative impact on quality measurements were attributed to patients poor oral intake, loss of body mass and minimal weight gains between dialysis sessions. Patients were observed to have a better quality of life and better utilization of time with family.

Conclusion

Palliative care, incorporating the patient and family, appears to be a good option for patients and families who are not ready to withdraw from dialysis. Palliative dialysis allows patients a slower transition to end-of-life care with more support and proper preparation in line with patients' wishes. In addition, with our recent experiences with covid 19 infections, this practice might be a possible option for someone with serious illness, hoping to avoid unwanted hospitalization and aggressive medical treatment. Goals of care conversation, timely plan of care for transition of care and close monitoring of patients are essential for palliative dialysis.