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Kidney Week

Abstract: PO0832

Palliative and Conservative Care Consultation in Hemodialysis: A Survey

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cohen, Karen, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States
  • Teehan, Geoffrey S., Lankenau Medical Center, Wynnewood, Pennsylvania, United States
Background

Prior to initiating dialysis for patients with End Stage Renal Disease (ESRD), options other than dialysis such as conservative or palliative care are under-utilized. There may be a subset of patients who may not be ideal candidates for dialysis. Conservative kidney management can address the symptoms of kidney failure and can articulate goals of care with or without dialysis. Given the costs of healthcare, high morbidity and mortality in the ESRD population, we believe greater attention to conservative care prior to dialysis would result in patients having more comprehensive information prior to initiating dialysis.

Methods

Patients were surveyed at a large for-profit dialysis center in the suburban Philadelphia area in late December 2020.They were administered a 5 question survey about recalled experiences regarding referral patterns prior to dialysis. Potential responses were "yes," "no," or "do not recall."

Results

37 patients were surveyed. Mean age was 63 years +/- 14, 70% were male, 95% were black. 24% of subjects reported discussing hospice and palliative care prior to dialysis initiation. 25% of patients >65 years old and 22% of patients <65 years old had such discussions. Chi square analysis was not statistically significant.

Conclusion

Only a small percentage of patients with ESRD on hemodialysis recall discussions about alternatives such as hospice, palliative, or conservative care prior to initiating dialysis. There is likely some recall bias. The current paradigm for initiating dialysis fails to routinely include conservative options potentially exposing subjects to increasing morbidity. We believe conservative care should be part of the informed consent process prior to starting dialysis.