Access to and characteristics of palliative care‐related hospitalization in the management of end‐stage renal disease patients on renal replacement therapy in France

• Published in: Nephrology (Carlton, Vic.) Vol. 22; no. 8; pp. 598 - 608
• Main Authors: Couchoud, Cécile, Arnaud, Del Bello, Lobbedez, Thierry, Blanchard, Sylvie, Chantrel, François, Maurizi‐Balzan, Jocelyne, Moranne, Olivier
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.08.2017; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Albumin; Cancer; death; Dialysis; dialysis withdrawal; End-stage renal disease; Female; France; Health Services Accessibility; Hospice care; Hospitalization; Human health and pathology; Humans; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Kidney transplantation; Life Sciences; Male; Medicare; Middle Aged; Palliation; Palliative Care; Registries; Renal Replacement Therapy; Time Factors; Treatment Outcome; Urology and Nephrology; Withholding Treatment; Young Adult; dialysis withdrawal; cancer; death; end-stage renal disease; palliative care
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12822

Aim Palliative care is seldom proposed to patients with end‐stage renal disease (ESRD) despite a mortality rate and disease burden as high as among cancer patients. The aim of this study is to analyze the access of palliative care‐related hospitalization in the management of patients on dialysis in France, by describing the characteristics of these hospitalizations, the clinical status of the concerned patients, and the use of palliative care in those stopping dialysis. Methods The French Renal Epidemiology and Information Network (REIN) registry includes data about 51 834 patients aged 20 years and older who began dialysis from 1 January 2008 to 31 December 2013, and were followed longitudinally until that date. Linkage to the anonymized national hospital discharge database allowed us to analyse hospitalizations associated with palliative care. Results During the follow‐up period, 1865 patients (3.6%) had a palliative care‐related hospitalization corresponding to a total of 3382 hospitalizations. Lower levels of serum albumin, active cancer, and impaired mobility were each independently associated with the probability of at least one such hospitalization. During the same period 4540 patients withdrew from dialysis (9% of the patients), 10% of them had a palliative care‐related hospitalization. Conclusion This study suggests that among ESRD patients, only a few resorted to palliative care‐related hospitalization, even those withdrawing from dialysis. Cooperation between nephrologists and physicians trained in palliative care should be improved at least to the extent necessary to identify patients who should be referred to palliative care. Our study also highlights the need for more information on the current access to any kind of supportive care for dialysis patients. Summary at a Glance The authors linked the French REIN registry with national hospital discharge database, and analyzed the current status of palliative care‐how bad it is‐in ESRD patients. It will definitely help for the readers to have interest in its importance.