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Abstract: FR-PO884

The Current Status of Advance Care Plan and Dialysis Withdrawal in Elderly Hemodialysis Patients in South Korea

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Lee, Jangwook, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Park, Woo Yeong, Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Yu, Byung chul, Soonchunhyang University Hospital Bucheon, Bucheon, Gyeonggi-do, Korea (the Republic of)
  • Han, Miyeun, National Medical Center, Seoul, Korea (the Republic of)
  • Song, Sang Heon, Pusan National University School of Medicine, Yangsan, Korea (the Republic of)
  • Yang, Jae Won, Wonju Severance Christian Hospital, Wonju, Korea (the Republic of)
  • Chung, Sungjin, Catholic University of Korea Yeouido Saint Mary's Hospital, Seoul, Korea (the Republic of)
  • Hong, Yu Ah, Catholic University of Korea Daejeon St Mary's Hospital, Daejeon, Daejeon, Korea (the Republic of)
  • Hyun, Young Youl, Kangbuk Samsung Hospital, Jongno-gu, Korea (the Republic of)
  • Bae, Eunjin, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsangnam-do, Korea (the Republic of)
  • Sun, In O, Presbyterian Medical Center, Jeonju, Jeollabuk-do , Korea (the Republic of)
  • Kim, Hyunsuk, Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-do, Korea (the Republic of)
  • Hwang, Won Min, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Kwon, Soon hyo, Soonchunhyang University Hospital, Seoul, Korea (the Republic of)
  • Yoo, Kyung Don, Ulsan University Hospital, Ulsan, Korea (the Republic of)
  • Jung, Jiyun, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Shin, Sung Joon, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)

Group or Team Name

  • Korean Society of Geriatric Nephrology (KSGN).
Background

Only a few studies have investigated end of life care or experiences of elderly hemodialysis patients. We aimed to explore advance care plan and dialysis withdrawal in elderly hemodialysis patients at the end of life in South Korea.

Methods

We analyzed medical data of elderly dialysis patients ( ≥70 years old) who died between January 1, 2010 and December 31, 2017, at 10 university hospitals in the Korean Society of Geriatric Nephrology (KSGN). We examined causes of death, the presence of advance care plan, and clinical variables related to dialysis and life-sustaining treatments.

Results

Of 404 deaths, 57.7% were male and the mean age was 77 years. Dialysis was maintained for an average of 792 days. The most common causes of death in elderly dialysis patients were infection, cardiovascular disease and malignancy accounting for 48.8%, 20% and 8.7% of cases, respectively. The overall rate of advance care planning including Do-Not-Resuscitate orders in these patients reached to 70%. Despite of the explicit expressions against life-sustaining treatment, ventilator care was provided in 45.3% and cardiopulmonary resuscitation was performed in 33.4% of the patients. Moreover, more than half (63.9%) continued to receive hemodialysis until three days before death (91.2% until two weeks prior to death).

Conclusion

Our findings imply the importance to respect patients' preferences and advance care plan when it comes to end of life care in elderly dialysis patients. Shared decision making could play a key role in that regard to resolve the discrepancy between advance care plan and actual provision of life-sustaining treatments at the end of life.

Funding

  • Other NIH Support