Infrequent Provision of Palliative Care to Patients with Dialysis-Requiring AKI

Clinical journal of the American Society of Nephrology: CJASN

Kelly Chong⁴ 

[1]and..

[2]and..*Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico

[3]and..†Division of Nephrology, Stanford University School of Medicine, Palo Alto, California

[4]*Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico

[5]†Division of Nephrology, Stanford University School of Medicine, Palo Alto, California

关键词: acute renal failure;    clinical epidemiology;    United States;    Comorbidity;    Logistic Models;    Inpatients;    Shock, Cardiogenic;    International Classification of Diseases;    Respiratory Distress Syndrome, Adult;    Palliative Care;    Acute Kidney Injury;    Hispanic Americans;    African Continental Ancestry Group;    Fluid Therapy;    Intracranial Hemorrhages;    Prognosis;    Demography;    Humans;    renal dialysis;   

DOI  :  10.2215/CJN.00270117

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives The use of palliative care in AKI is not well described. We sought to better understand palliative care practice patterns for hospitalized patients with AKI requiring dialysis in the United States.Design, setting, participants, & measurements Using the 2012 National Inpatient Sample, we identified patients with AKI and palliative care encounters using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We compared palliative care encounters in patients with AKI requiring dialysis, patients with AKI not requiring dialysis, and patients without AKI. We described the provision of palliative care in patients with AKI requiring dialysis and compared the frequency of palliative care encounters for patients with AKI requiring dialysis with that for patients with other illnesses with similarly poor prognoses. We used logistic regression to determine factors associated with the provision of palliative care, adjusting for demographics, hospital-level variables, and patient comorbidities.Results We identified 3,031,036 patients with AKI, of whom 91,850 (3%) received dialysis. We observed significant patient- and hospital-level differences in the provision of palliative care for patients with AKI requiring dialysis; adjusted odds were 26% (95% confidence interval, 12% to 38%) lower in blacks and 23% (95% confidence interval, 3% to 39%) lower in Hispanics relative to whites. Lower provision of palliative care was observed for rural and urban nonteaching hospitals relative to urban teaching hospitals, small and medium hospitals relative to large hospitals, and hospitals in the Northeast compared with the South. After adjusting for age and sex, there was low utilization of palliative care services for patients with AKI requiring dialysis (8%)—comparable with rates of utilization by patients with other illnesses with poor prognosis, including cardiogenic shock (9%), intracranial hemorrhage (10%), and acute respiratory distress syndrome (10%).Conclusions The provision of palliative care varied widely by patient and facility characteristics. Palliative care was infrequently used in hospitalized patients with AKI requiring dialysis, despite its poor prognosis and the regular application of life-sustaining therapy.

【 授权许可】

CC BY