End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy

Clinical Journal of the American Society of Nephrology : CJASN
Joy Chieh-Yu ChenLaTonya J Hickson

Abstract

Withdrawal from maintenance hemodialysis before death has become more common because of high disease and treatment burden. The study objective was to identify patient factors and examine the terminal course associated with hemodialysis withdrawal, and assess patterns of palliative care involvement before death among patients on maintenance hemodialysis. We designed an observational cohort study of adult patients on incident hemodialysis in a midwestern United States tertiary center, from January 2001 to November 2013, with death events through to November 2015. Logistic regression models evaluated associations between patient characteristics and withdrawal status and palliative care service utilization. Among 1226 patients, 536 died and 262 (49% of 536) withdrew. A random sample (10%; 52 out of 536) review of Death Notification Forms revealed 73% sensitivity for withdrawal. Risk factors for withdrawal before death included older age, white race, palliative care consultation within 6 months, hospitalization within 30 days, cerebrovascular disease, and no coronary artery disease. Most withdrawal decisions were made by patients (60%) or a family member (33%; surrogates). The majority withdrew either because of acute medical compli...Continue Reading

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Jul 22, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Vanessa Grubbs
Apr 11, 2019·Seminars in Dialysis·Ann M O'HareClaire A Richards
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Feb 20, 2021·Journal of Palliative Medicine·Jennifer St Clair RussellAmber Paulus
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Nov 14, 2020·Journal of Palliative Medicine·Alina SiddiquiClaire K Ankuda
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