Kidney Week

Abstract: FR-PO1095

Palliative Care and Hospice Utilization in US Veterans Treated with Conservative Management vs. Dialysis

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Narasaki, Yoko, University of California Los Angeles, Los Angeles, California, United States

Yoko Narasaki, MS, PhD

• Rhee, Connie, University of California Los Angeles, Los Angeles, California, United States

Connie Rhee, MD, MS

• You, Amy Seungsook, University of California Los Angeles, Los Angeles, California, United States

Amy Seungsook You, MS

• Siu, Man Kit Michael, University of California Los Angeles, Los Angeles, California, United States

Man Kit Michael Siu, MD, MS

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Yoon, Ji Hoon, University of California Los Angeles, Los Angeles, California, United States

Ji Hoon Yoon, MS

• Le, Lisa, University of California Los Angeles, Los Angeles, California, United States

Lisa Le

• Nguyen, Danh V., University of California Irvine, Irvine, California, United States

Danh V. Nguyen, PhD

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

Background

There is growing need for the role of palliative care in the routine nephrology management of the advanced CKD population given the high physical and psychological symptom burden of these patients, particularly among those who are aging and ailing. However, the utilization of palliative and hospice care services among advanced CKD patients in the US has not been well-studied. We thus sought to examine palliative and hospice care utilization among advanced CKD patients treated with conservative management (CM) vs. dialysis in a national cohort of US Veterans.

Methods

Using national Veterans Affairs (VA) data linked with the USRDS and Medicare databases, we examined advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis (defined as non-receipt vs. receipt of dialysis within 2-years of 1^st eGFR <25) over 2010-19. We compared time to 1^st referral to palliative care (primary outcome) or hospice (secondary outcome) among CM vs. dialysis patients who were matched by propensity score (PS) using a 1:1 ratio with a caliper distance of ≤0.2 to address confounding using Cox models.

Results

Baseline characteristics were well-balanced among 13,020 CM patients PS-matched to 13,020 dialysis patients. In PS-matched analyses, patients treated with dialysis had a lower likelihood of both palliative and hospice care referral compared to those treated with CM: HR (95%CI) 0.78 (0.72-0.84) and 0.57 (0.52-0.62), respectively (Figures 1A &1B). We observed similar findings in analyses doubly-adjusted for PS covariates.

Conclusion

In a national cohort of US Veterans with advanced CKD, those who transitioned to dialysis were less likely to be referred to palliative or hospice care than those treated with CM. Further studies are needed to determine factors contributing to differential palliative/hospice care utilization in advanced CKD patients treated with CM vs. dialysis.

Funding

• NIDDK Support