Abstract: SA-PO0349
Health Care Use at End of Life Among Patients with 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
- Weinhandl, Eric D., DaVita Inc, Denver, Colorado, United States
- Sibbel, Scott, DaVita Inc, Denver, Colorado, United States
- Tentori, Francesca, DaVita Inc, Denver, Colorado, United States
Background
Among patients undergoing maintenance dialysis in the United States during 2022, there were more than 104,000 deaths. Thus, decisions about health care at the end of life (EOL) are commonly encountered. Throughout all of Medicare, expenditures among decedents are more than three times higher than typical. Relatively little is known about health care utilization in dialysis patients at EOL.
Methods
We identified a cohort of patients undergoing maintenance dialysis at the time of death, who had (a) died in 2024 and (b) continuously carried original Medicare coverage during the 6-month interval preceding the date of death. We analyzed Medicare Parts A and B claims to estimate monthly rates of hospital admission, hospitalized days, intensive care unit (ICU) admissions, and cumulative Medicare payments during each of the last 6 months of life.
Results
The cohort comprised of 3,450 deceased patients. During the last 6 months of life, all rates of health care utilization and Medicare payments increased monotonically (table). Furthermore, relative changes from one month to the next themselves accelerated during the 6-month interval. During the last month of life, roughly 30% of patient-days were spent in the hospital, and Medicare payments were roughly 4 times higher than only five months earlier.
Conclusion
In dialysis patients with original Medicare coverage, utilization of inpatient care and total spending increase sharply at EOL, especially during the last 3 months. Improved coordination of care, including referral to palliative care and hospice, may reduce dependence on high-intensity acute care, reduce costs to Medicare, and improve the EOL experiences of dialysis patients and their families.
| Month before death | Hospital Admissions | Hospitalized Days | ICU Admissions | Medicare Payments |
| Population Average | 0.14 | 0.98 | --- | $7,523 |
| 6th | 0.19 | 1.85 | 0.10 | $8,643 |
| 5th | 0.21 | 2.14 | 0.11 | $9,694 |
| 4th | 0.24 | 2.54 | 0.12 | $10,088 |
| 3rd | 0.30 | 3.08 | 0.16 | $12,178 |
| 2nd | 0.40 | 4.48 | 0.22 | $13,683 |
| Last | 0.75 | 9.02 | 0.52 | $35,798 |
All rates are enumerated per patient-month. Population averages reflect all dialysis patients with Medicare coverage (USRDS Reference Tables G and K).