Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD

Abstract: Little is known about the quality of end-of-life care for patients with advanced Chronic Kidney Disease (CKD). The authors describe the relationship between patterns of end-of-life care and dialysis treatment with family-reported quality of end-of-life care in this population of veterans. The study was an observational one, using a national group of 9993 veterans with advanced CKD who died in Department of Veterans Affairs facilities between 2009 and 2015. They looked at associations between patterns of end-of-life care and receipt of dialysis-a kidney machine (no dialysis, acute dialysis, maintenance dialysis) with family-reported quality of end-of-life care. Overall, 52% of patients spent ≥2 weeks in the hospital in the last 90 days of life, 34% received an intensive procedure, and 47% were admitted to the intensive care unit, in the last 30 days, 31% died in the intensive care unit, 38% received a palliative care consultation in the last 90 days, and 36% were receiving hospice services at the time of death. Most did not receive dialysis, 12% received a short period dialysis, and 34% received longer term dialysis. Patients treated with acute or maintenance dialysis had more intensive patterns of end-of-life care than those not treated with dialysis. Receipt of longer (but not short term) dialysis and more intensive patterns of end-of-life care were associated with lower overall family ratings of end-of-life care, whereas receipt of palliative care and hospice services were associated with higher overall ratings. Among patients with advanced CKD, care focused on life extension rather than comfort was associated with lower family ratings of end-of-life care regardless of whether patients had received dialysis.