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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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“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]
In the citing paper
“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]
In the citing paper
“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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BackgroundResultInfluentialHospice Use And End-Of-Life Spending Trajectories In Medicare Beneficiaries On Hemodialysis
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Davidson, S., Murtagh, F. E., & Higginson, I. J. (2008) · PubMed · Cited by 18
Renal Supportive Care: View from Across the Pond: The United States Perspective
Germain, M. J., & Cohen, L. M. (2007) · Journal of Palliative Medicine · doi:10.1089/jpm.2006.0252 · Cited by 17
Pollock, C. A., James, G., Sánchez, J. J. G., Arnold, M., Carrero, J. J., Lam, C. S. P., Chen, H., NOLAN, S. T., & Pecoits‐Filho, R. (2022) · Advances in Therapy · doi:10.1007/s12325-021-02010-3 · Cited by 17
“Although patients may opt to die in a hospice rather than in hospital, available data suggest that utilisation of hospice care by patients with CKD on dialysis (haemodialysis or peritoneal dialysis) is low [47–49], with approximately half as many patients with kidney failure utilising hospice care compared with patien…”
BackgroundResultFamily Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD
Richards, C. A., Liu, C., Hebert, P. L., Ersek, M. T., Wachterman, M. W., Reinke, L. F., Taylor, L., & O’Hare, A. M. (2019) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.01560219 · Cited by 18
“Third, our findings may not be generalizable to patients with advanced CKD not included in this study, including non-veterans and veterans who died at home or in a non-VA facility (Supplemental Table 8) (32).”
BackgroundJablonski, A. (2007) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2007.00394.x · Cited by 17
“Patients with ESRD are rarely admitted to hospice unless they have opted to discontinue dialysis (12) or suffer from a comorbid condition with a life expectancy of 6 months or less (11).”
BackgroundPalliative dialysis: Addressing the need for alternative dialysis delivery modes
Tentori, F., Hunt, A., & Nissenson, A. R. (2019) · Seminars in Dialysis · doi:10.1111/sdi.12820 · Cited by 17
Cross, S. H., Lakin, J. R., Mendu, M. L., Mandel, E. I., & Warraich, H. J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.001 · Cited by 16
Hemodialysis as a life-sustaining treatment at the end of life
Shin, S. J., & Lee, J. H. (2018) · Kidney Research and Clinical Practice · doi:10.23876/j.krcp.2018.37.2.112 · Cited by 16
“In spite of high annual mortality rates in dialysis patients, hospice services have not been properly provided to dialysis patients in comparison to patients with other diagnoses [34].”
ResultDeath during hospitalization in patients on chronic hemodialysis
Behl, M., Sun, Y., Agaba, E. I., Martinez, M., Servilla, K. S., Raj, D. S., Murata, G. H., & Tzamaloukas, A. H. (2010) · Hemodialysis International · doi:10.1111/j.1542-4758.2010.00485.x · Cited by 15
Phair, G., Agus, A. M., Normand, C. E. M., Brazil, K., Burns, A. P., Roderick, P. J., Maxwell, A. P., Thompson, C., Yaqoob, M. M., & Noble, H. R. (2018) · Palliative Medicine · doi:10.1177/0269216318775247 · Cited by 15
“In a study examining the use of conservative care via hospice services in dialysis patients in the USA, there was a reduction in the number of hospital visits compared to those who did not use hospices [12].”
BackgroundThematic Analysis of Hospice Mentions in the Health Records of Veterans with Advanced Kidney Disease
O’Hare, A. M., Butler, C. R., Taylor, J. S., Wong, S. P. Y., Vig, E. K., Laundry, R. J., Wachterman, M. W., Hebert, P. L., Liu, C., Burrows, N. R., et al. (2020) · Journal of the American Society of Nephrology · doi:10.1681/asn.2020040473 · Cited by 15
Conservative (non dialytic) management of end-stage renal disease and withdrawal of dialysis
Murtagh, F. E., Spagnolo, A. G., Panocchia, N., & Gambaro, G. (2009) · Progress in Palliative Care · doi:10.1179/096992609x12455871937143 · Cited by 15
Palliative and end-of-life care in nephrology
Eneanya, N. D., Paasche‐Orlow, M. K., & Volandes, A. E. (2017) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000337 · Cited by 15
Agunbiade, A., Dasgupta, A., & Ward, M. M. (2019) · Journal of the American Society of Nephrology · doi:10.1681/asn.2019020122 · Cited by 14
Diamond, L. H., Armistead, N. C., Lupu, D., Moss, A. H., Anderson, E. H., Armistead, N. C., Diamond, L. H., Harbert, G., Lam, D. Y., Lupu, D., et al. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2020.09.020 · Cited by 12
“than 50% of persons with cancer, and only 3% received concurrent hospice and dialysis care.(32) The situation has improved, with 27% of Medicare ESRD decedents using hospice in 2015.”
BackgroundSelf-citationPalliative Dialysis: A Change of Perspective
Romano, T. G. (2014) · Journal of Clinical Medicine Research · doi:10.14740/jocmr1773w · Cited by 12
“9% of those patients used hospice facilities with cost reduction from the public health system [25].”
BackgroundButler, C. R., Schwarze, M. L., Katz, R., Hailpern, S. M., Kreuter, W., Hall, Y. N., Montez‐Rath, M. E., & O’Hare, A. M. (2019) · Journal of the American Society of Nephrology · doi:10.1681/asn.2018101002 · Cited by 12
Ogawa, A., Nouno, J., Shirai, Y., Shibayama, O., Kondo, K., Yokoo, M., Takei, H., Koga, H., Fujisawa, D., Shimizu, K., et al. (2011) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyr174 · Cited by 12
“01 40 and ,80% 28 (35) 43 (28) ,40% 15 (19) 56 (37)”
ResultBrowne, T. A., Merighi, J. R., Washington, T. R., Savage, T. E., Shaver, C., & Holland, K. (2019) · doi:10.1002/9781119420743.ch18 · Cited by 12
Wachterman, M. W., Corneau, E. A., O’Hare, A. M., Keating, N. L., & Mor, V. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.3708 · Cited by 10
Khou, V., Mata, N. L. D. L., Morton, R. L., Kelly, P. J., & Webster, A. C. (2020) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaa105 · Cited by 10
Opportunities to Improve End-of-Life Care in ESRD
Schell, J. O., & Holley, J. L. (2013) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.10321013 · Cited by 9
“20%, dialysis patients are half as likely to receive hospice services compared with other hospice diagnoses (3).”
BackgroundAssociation of Race and Poverty With Mortality Among Nursing Home Residents on Maintenance Dialysis
Nee, R., Thurlow, J. S., Norris, K. C., Yuan, C. M., Watson, M. A., Agodoa, L. Y. C., & Abbott, K. C. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.02.013 · Cited by 8
End-of-life matters in chronic renal failure
Berman, N. (2014) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000097 · Cited by 8
“1751-4258 2014 Wolters Kluwer Health | Lippincott Williams & Wilk services, as compared with nearly 50% of cancer patients [63].”
BackgroundRenal palliative and supportive care in South Africa – a consensus statement
Wearne, N., Krause, R., Davidson, B. J., & Brennan, F. P. (2020) · African Journal of Nephrology · doi:10.21804/23-1-4009 · Cited by 7
“the ideal model for palliative care in cKD [16] Healthcare utilisation in advanced CKD is high [50].”
BackgroundInitiation of Dialysis at Higher Levels of Estimated GFR and Subsequent Withdrawal
O’Hare, A. M., Vig, E. K., & Hebert, P. L. (2013) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.12841212 · Cited by 7
Metadata
- 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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