DIALYSIS WITHDRAWAL: HOW DO OUR PATIENTS DIE? – A RETROSPECTIVE SINGLE-SITE STUDY
A DELLA GATTA1,2, R DAVID1, C JONES1, R PAIS1,2 1Royal Prince Alfred Hospital, Sydney, NSW, Australia2University of Sydney, Sydney, NSW, Australia
Abstract
Aim: To describe dialysis withdrawal (DW) trajectory, from decision until patient death; and, to determine current Renal Supportive Care involvement (RSC), and any influencing patient factors.
Background: Australian patients with end-stage kidney disease (ESKD) discontinue maintenance dialysis at an internationally elevated rate. However, quantitative data on dialysis withdrawal and the post-withdrawal disease trajectory is scarce, limiting capacity for RSC to optimise quality of dying for these patients.
Methods: A retrospective chart review was performed for 110 chronic dialysis patients at Royal Prince Alfred Hospital (RPAH; Sydney, Australia), who died between 2012 and 2022. Domains investigated included patient background characteristics, decision to withdraw, reported post-DW symptoms and prescribed medications, survival time, location of death, and RSC involvement.
Results: DW discussions were more frequently initiated by physicians (62.9%), and in response to biomedical factors. The post-withdrawal trajectory demonstrated a high symptom burden, and accordant medical management. The majority of patients died in hospital, and post-DW survival time demonstrated association with several patient factors. Since its introduction in our unit in 2016, RSC involvement following DW grew significantly to 100% in 2022 (p<0.01); however, only 43.2% of patients had received RSC (or palliative care) input prior to the decision to withdraw.
Conclusion: Dialysis withdrawal is a leading cause of death in the dialysis population. The widespread involvement of specialised RSC teams has the potential to effectively target symptoms at end of life, and assist with other psychosocial issues.
Biography
I am an Advanced Trainee in Nephrology working in the Central-South Western-Regional network in NSW. I am interested in chronic kidney disease and general nephrology, and in improving provision of care to our patients.