Revista Portuguesa de Nefrologia e Hipertensão (Mar 2023)
How do our Dialysis Patients Die?
Abstract
Introduction: Elderly patients are the most frequent patients admitted to dialysis units. Relatively little is known about standards on endof-life (EOL) care among dialysis patients. From international literature, these patients are exposed to more aggressive treatments at EOL than patients with cancer or other chronic diseases and palliative referral is infrequent. This study aims to describe some end-of-life (EOL) practices in patients undergoing hemodialysis in NephroCare clinics in several cities in Portugal. Material and Methods: We designed a prospective, multicenter, observational, cross-sectional study conducted between October 1st, 2020 and September 30th, 2021 in six hemodialysis clinics including 1265 patients (pts). Results: During the year in analysis, 158 pts died (12.4%). Mean age was 76 years (25% of pts were older than 85 years) and dialysis vintage was 84 (2-963) months. Regarding comorbidities, 50% were diabetic, 40% had congestive heart failure, 25% had cancer and 17% had dementia. Mean age-adapted Charlson index was 13 ± 3. For 82 pts (51.9%), nephrologists would not be surprised if they died in the next 6 months. Seventy-three had hospital admissions in the previous three months. Four pts withdrew dialysis. Of those who died, only two had advance care directives, 18 had an opioid prescription in the last month of life and 17 were referred to palliative intervention mostly because of oncologic disorders. Seventy four percent of these pts died at the hospital and 23% died at home/nursing home. Not a single patient died under hospice care. Conclusion: Most of our patients commonly die in hospital, undergo invasive procedures, spend much of their remaining life fulfilling a demanding dialysis schedule and are admitted to the hospital wards without formal palliative intervention or discussion of goals of care, even when death is an expected outcome.
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