Use of Hospice in the United States Dialysis Population
Abstract
Hospice is recognized for providing excellent end-of-life care but may be underused by dialysis patients. Hospice use and related outcomes were measured among dialysis patients, and factors that were associated with hospice use were identified. The 2-yr US Renal Data System dialysis patients who died between January 1, 2001, and December 31, 2002, and hospice claims from the Centers for Medicare & Medicaid Services were examined to measure prevalence, factors, and costs that were associated with dialysis withdrawal and hospice use. Of the 115,239 deceased patients, 21.8% withdrew from dialysis and 13.5% used hospice. Of those who withdrew, 41.9% used hospice. Failure to thrive was the most common reason for dialysis withdrawal (42.9%). On multivariable logistic regression analysis, factors that were significantly associated with hospice referral among patients who withdrew from dialysis were age, race, reason for withdrawal, ability to walk or transfer at dialysis initiation, and state of residence. Among patients who withdrew from dialysis and used hospice, median cost of per-patient care during the last week of life was $1858, compared with $4878 for nonhospice patients (P < 0.001); hospitalization costs accounted for most of that difference. Only 22.9% of dialysis hospice patients died in the hospital, compared with 69.0% of nonhospice patients (P < 0.001). A minority of dialysis patients use hospice, even among patients who withdrew from dialysis, whose death usually is certain. Increased hospice use may enable more dialysis patients to die at home, with substantial cost savings. Research regarding additional benefits of hospice care for dialysis patients is needed.
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Even though survival after starting dialysis is known to be poor, advance care planning is uncommon.
“Despite knowledge of poor survival after dialysis initiation, advance care planning occurs infrequently [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [9]
Patients want prognostic information and advance care planning, but these happen rarely.
“Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently.”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [9]
ESRD patients who discuss end-of-life care with a clinician are more likely to complete advance directives.
“ESRD patients who have end-of-life discussions with a healthcare provider are more likely to complete advance directives [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [9]
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- Authors
- Murray, A. M., Arko, C., Chen, S.-C., Gilbertson, D. T., & Moss, A. H.
- Affiliations
- Hennepin County Medical Center (US)
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2006-11
- Volume
- 1
- Issue
- 6
- Pages
- 1248-1255
- ISSN
- 1555-9041 (ISSN-L)
- OpenAlex
- W2149481791
- Cited by
- 156
- References
- 23
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 12 · 2018: 14 · 2017: 10 · 2016: 12 · 2015: 11 · 2014: 9 · 2013: 18 · 2012: 13
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (N01-DK-9-2343)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- hospice care, dialysis patients, end-of-life care, dialysis withdrawal, home death, hospital costs, failure to thrive, United States Renal Data System
- MeSH terms
- Aged, Aged, 80 and over, Cause of Death, Costs and Cost Analysis, Female, Medicare, Hospices, Humans, Male, Medicaid, Middle Aged, United States, Cohort Studies, Survival Analysis
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