Data that was presented at the American Society of Nephrology (ASN) Kidney Week meeting (2–5 November 2023, Philadelphia, USA) shows that patients who have ceased dialysis treatments “typically survive around one week”, with most patients dying in acute care settings, despite this being “often not in keeping with their wishes,” according to Kirsten Hepburn (Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia) et al.
With Kidney Supportive Care (KSC) services that have grown to match the palliative care needs of patients who have stopped receiving dialysis treatment, this study sought to examine the “the profile and survival of patients known to a KSC service who withdrew from dialysis”, as stated in the abstract that was presented on the second day of ASN Kidney Week. To do this, retrospective analysis of patients known to a KSC service from 2016—2023 who withdrew from haemodialysis (HD) or peritoneal dialysis (PD) was conducted, looking at demographics such as age, sex, ethnicity and Charlson Comorbidity Index (CCI), which were extracted from medical records.
Of the 157 patients that withdrew from dialysis treatment over the seven-year period that were included in the review, 132 of those had withdrawn from HD and 25 from PD. The study found that, after withdrawing from dialysis, patients survived a median of seven days (Interquartile range [IQR] 7.75) after HD and six days after ceasing PD (IQR 9.5).
The study also reviewed the setting in which these patients died; 50% of patients died in an acute hospital, 24% at home and 23% in a palliative care unit (PCU). However, some patients had expressed that this was not their desired or requested location. Hepburn et al found that 74 of the 157 patients indicated that they had a preferred place of death; 35 (47%) indicated that they wished to die at home, but only 16 (46%) of these patients did so. 16 patients (22%) said that they wanted to die in a PCU, but 11 (69%) did so. Finally, 19 people (26%) indicated that they wanted to die in an acute hospital and 14 (74%) of those patients did. The authors of the study suggest that the reason for this disparity between desired location and actual location “may have been due to acute medical complications or sudden deterioration limiting transfer to their preferred place of death” but that “further work is needed to understand how best to provide care that concords with end-of-life preferences”.