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Kidney Week

Abstract: FR-PO451

Withdrawal from Dialysis: Seven-Year Experience in a Kidney Supportive Care Service

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hepburn, Kirsten S., Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Hudson, Rebecca, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Austin, Laura H., Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Purtell, Louise, School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
  • Ng, Monica S., Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Berquier, Ilse R., Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Kramer, Katrina Maree, Palliative and Supportive Care Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Bonner, Ann, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Healy, Helen G., Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
Background

Withdrawal from dialysis is a common cause of death in patients on dialysis. Kidney Supportive Care (KSC) services have evolved to meet the palliative care needs of patients ceasing dialysis when it is no longer beneficial. This study examines the profile and survival of patients known to a KSC service who withdrew from dialysis.

Methods

Retrospective analysis of patients known to a KSC service between 2016 and 2023 who withdrew from haemodialysis (HD) or peritoneal dialysis (PD). Demographics including age, sex, ethnicity, and Charlson Comorbidity index (CCI) were extracted from medical records. Reason for referral to KSC and patient choices including advance care planning (ACP) documents and preferred place of death were recorded. Date of dialysis withdrawal, date and place of death; and referral to palliative care services were also collected. Results were analyzed descriptively.

Results

Over 7 years, 157 patients withdrew from dialysis with a mean age of 72.4 years (SD 9.88). 38% were female and 3% identified as First Nations people. 132 patients withdrew from HD and 25 from PD. At time of referral to KSC, the median CCI was 7 (IQR 2), 31% had either ischaemic heart or congestive cardiac failure, and 5% had a diagnosis of dementia. Patients withdrew from dialysis a median of 205 days (IQR 440) after KSC referral. Following withdrawal from HD patients survived a median of 7 days (IQR 7.75), and 6 days after withdrawal from PD (IQR 9.5). 50% of people died in an acute hospital, 24% at home and 23% in a palliative care unit (PCU). Of the 74 who had indicated preferred place of death, 35 (47%) wished to die at home; of these 16 (46%) did. Only 16 patients (22%) wished to die in a PCU, but 11 (69%) did. Surprisingly 19 patients (26%) indicated they wished to die in an acute hospital and 14 (74%) of these patients did.

Conclusion

Our results indicate that patients typically survive around one week after withdrawal from dialysis, which is consistent with current literature. Most patients died in acute care settings, which was often not in keeping with their wishes. This may have been due to acute medical complications or sudden deterioration limiting transfer to their preferred place of death. Further work is needed to understand how best to provide care that concords with end-of-life preferences.