Thursday, May 10, 2012

IN the NEWS: Intensive treatment during end of life for dialysis patients?

Type of careDialysis patientsCancer patients
Average number of days hospitalized9.85.1
Intensive care unit48.9%24.0%
Average number of days in ICU3.51.3
Ventilator, feeding tube or CPR29.0%9.0%
In-hospital death44.8%29.0%
This is a table just seen in a recent article in Archives of Internal medicine on intensity of treatment at the end of life in older adults receiving long term dialysis.  It is an interesting comparison of cancer patients to dialysis patients and one notices that while cancer patients are sick, dialysis patients are sicker and have a higher mortality. Hospitalizations are more, average length of stay and even average intensive care stays are higher. Hospice is rarely offered or chosen in dialysis patients. Check out a post regarding this topic recently as well. Part of this is perhaps Nephrologists are not comfortable offering end of life care to the elderly sick patients during their end of life. Forgoing dialysis is hard for the practicing Nephrologists. 
Are our Nephrologists in training comfortable in dealing with end of life issues and providing "No dialysis" in the right circumstance. 
And how are they compare to their counterparts in cardiology, oncology, and critical care? 
We don't know. 
For that, we have created a survey for our fellows to take. Please pass this along to all nephrology fellows you know as this is very important question to answer.


  1. I suspect a major part of the reason is financial. If a dialysis patient is made palliative, then he/she no longer generates income for the nephrologist or the clinic. An empty chair generates no income, so the incentive is to keep the patient alive, no matter what the quality of life is.

    I agree that mandatory palliative medicine curricula needs to incorporated into fellowship training; but more importantly train fellows ( and may be practising nephrologists also ) that all patients donot need to go on dialysis when they reach ESRD

  2. I agree.. thats why dialysis is bankrupting Medicare.
    I like to use this equation to give my patients (and the families of my patients) an idea of what their prognosis would be like on dialysis:


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