Renal patients at end of life: A 5-year retrospective review

Abstract

Context: Patients with end-stage renal disease (ESRD) have a life-limiting illness associated with significant morbidity. The ‘tipping point’ where increased medical and supportive care is needed urgently can be missed. It cannot be assumed that specialist palliative care (SPC) services which evolved to care for patients with cancer will also be right for patients with different diagnoses.Objectives: To review retrospectively the end-of-life care of patients receiving renal replacement therapy (RRT) from our institution.Methods: We conducted a single-centre retrospective cohort study. We reviewed medical charts and electronic records to record patient characteristics, mode of dialysis, place of death and the time spent in hospital.Results: One hundred and sixty-one patients were included in our study. The mean age at death was 63 years and 68% were male. In their last year of life, patients spent a median of 53 days as inpatients with a median of three admissions. The haemodialysis cohort spent a median of 59 inpatient days in their last year of life, excluding day case attendances. One hundred and twenty-two (76%) patients died in hospital, 103 of those in our institution. Twenty-seven (17%) patients died at home while four (2%) died in an inpatient hospice unit. Preference for place of care was documented for 33 (20%) patients. Overall, 56 (35%) patients were referred to SPC.Conclusion: End-of-life planning should be a more regular goal in all patients on RRT. Given the frequency of hospital attendance, opportunities should be grasped to make advance plans to facilitate patients’ wishes.