Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

Abstract

Objectives: Patients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life.

Design: A population-based retrospective observational study.

Setting: This study used a population database maintained by Taiwan's Ministry of Health and Welfare in combination with Taiwan's National Health Research Insurance Database.

Participants: We enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan.

Main exposure measure: Hospice care during the 1-year period before death.

Main outcome measures: Eight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation.

Results: A total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: -0.09, CI: -0.10 to -0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death.

Conclusions: Palliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.

Keywords: aggressiveness; dialysis; kidney failure; palliative care; palliative care consultation service.