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Kidney Week

Abstract: SA-PO1111

Palliative and Hospice Care Utilization Among a National Cohort of Advanced CKD Patients Treated with Conservative Management vs. Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Narasaki, Yoko, University of California Irvine School of Medicine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
  • Yoon, Ji Hoon, University of California Irvine School of Medicine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mukamel, Dana B., University of California Irvine School of Medicine, Irvine, California, United States
  • Crowley, Susan T., Yale University, New Haven, Connecticut, United States
  • Le, Lisa, University of California Irvine School of Medicine, Irvine, California, United States
  • You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States
  • Nguyen, Danh V., University of California Irvine School of Medicine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine School of Medicine, Irvine, California, United States
Background

Given the high symptom burden of the aging and ailing advanced CKD population, there is compelling need for palliative or hospice care in routine nephrology management to optimize quality of life. Little is known about the comparative utilization of palliative/hospice care in advanced CKD patients treated with conservative management (CM) vs. dialysis.

Methods

We examined a national cohort of advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis (defined as non-receipt vs. receipt of dialysis within 2-years of 1st eGFR <25) over 1/1/07-6/30/20 from the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical/pharmacy claims and enrollment records for commercial/Medicare Advantage enrollees, and EHR data. We compared time to 1st referral to palliative care (primary outcome) or hospice (secondary outcome) among CM vs. dialysis patients who were matched by propensity score (PS) in a 1:1 ratio with a caliper distance of ≤0.2 to address confounding using Cox models.

Results

Among 28,740 CM patients PS-matched to 28,740 patients who transitioned to dialysis, baseline characteristics were well-balanced. In the PS-matched model, compared to CM, dialysis was associated with higher likelihood of palliative care referral: HR (95%CI) 1.29 (1.23-1.35). In contrast, dialysis was associated with lower likelihood of hospice referral vs. CM: HR (95%CI) 0.80 (0.77-0.84). Similar findings were observed in analyses doubly-adjusted for PS covariates.

Conclusion

In a national advanced CKD cohort, compared to patients treated with CM, those who transitioned to dialysis had higher palliative care referral yet lower hospice utilization. Further studies are needed to determine the underlying factors contributing to the differential utilization of palliative care vs. hospice among advanced CKD patients transitioning to CM vs. dialysis.

Funding

  • NIDDK Support