Abstract: SA-PO0346
Specialty Palliative Care Trends in ESKD
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Vita, Alexandra Julia, University of Michigan, Ann Arbor, Michigan, United States
- Bailoor, Kunal, University of Michigan, Ann Arbor, Michigan, United States
- Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
- Guro, Paula A, University of Michigan, Ann Arbor, Michigan, United States
- Oerline, Mary K., University of Michigan, Ann Arbor, Michigan, United States
- Hollingsworth, John M., University of Florida, Gainesville, Florida, United States
- Jawed, Areeba, University of Michigan, Ann Arbor, Michigan, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
Background
Patients with end-stage kidney disease (ESKD) have similar palliative care needs to patients with serious diseases such as cancer, but are less likely to receive specialty palliative care. We examined whether use of specialty palliative care for patients with ESKD changed in recent years, given increasing palliative care use in other contexts
Methods
We used national Medicare claims to identify patients on maintenance dialysis between 2017 and 2023. The primary outcome was use of any specialty palliative care, based on a validated diagnosis code or an evaluation and management claim. We also examined trends in outpatient and inpatient specific specialty palliative care. We assessed time trends in the overall population and in a sub-population of patients who were both age 75 or older and in the highest quartile by number of hierarchical condition categories (HCCs, a measure of comorbidity). This sub-population was felt to have greater palliative care needs. We used a logistic regression model with the outcome of use of specialty palliative care and patient covariates to examine whether changes in use occurred independent of changes in the underlying patient population
Results
The percentage of patients with ESKD using specialty palliative care grew from 4.5% in 2017 to 6.5% in 2023, a 43% relative increase, driven by inpatient use (Figure). In the sub-population of patients with ESKD who were both aged 75 or older and in the top quartile by number of HCCs, there was greater use of specialty palliative care and similar time trends, growing from 11.1% in 2017 to 15.9% in 2023. These time trends remained significant when adjusting for patient covariates. Palliative care use was more likely in patients with higher socioeconomic status, greater burden of comorbidity, and in patients of White race
Conclusion
Palliative care use increased in patients on dialysis even when controlling for changes in the characteristics of the underlying patient population, with persistent racial and socioeconomic gaps
Funding
- NIDDK Support