Division of Nephrology, Department of Medicine, Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA.
Department of Medicine, Upstate Medical University, 750 East Adams St, Syracuse, NY, 13210, USA.
J Nephrol. 2023 Sep;36(7):2081-2090. doi: 10.1007/s40620-023-01721-w. Epub 2023 Aug 9.
The predictors and latest trends in hospice utilization, adequate duration of hospice care, and dialysis discontinuation without hospice enrollment among patients with end stage kidney disease are not fully known; the aim of this study was to assess them, analysing data from the United States Renal Data System.
Data from the United States Renal Data System for patients with kidney failure who died between January 1, 2012, and December 31, 2019, were analyzed. Chi-square and logistic regression were used to evaluate associations between outcomes of interest and predictors, while Joinpoint regression was used to examine trends.
Among 803,049 patients, the median (IQR) age was 71 (17) years, 57% were male, 27% enrolled in hospice, 8% discontinued dialysis before death without hospice enrollment, and 7% remained in hospice for ≥ 15 days. Patients 65 years and older (adjusted odds ratio [aOR]: 2.75, 95% CI 2.71-2.79) and White race (aOR: 1.79, 95% CI 1.77-1.81) were more likely to enroll in hospice. White patients (aOR: 0.75, 95% CI 0.73-0.76) and those who never received a kidney transplant (aOR: 0.75, 95% CI 0.73-0.78) were less likely to have adequate duration of hospice care. Hospice enrollment and standardized duration of hospice care increased over time, with an average annual percentage change of 1.1% (95% CI 0.6-1.6) and 5% (95% CI 2.6-7.4), respectively.
Approximately one in every four patients with kidney failure who died between 2012 and 2019 had a history of hospice enrollment, while one in every 12 discontinued dialysis before death without hospice enrollment. There was an upward trend in the duration of hospice care.
终末期肾病患者的临终关怀利用、临终关怀持续时间和未登记临终关怀即停止透析的预测因素和最新趋势尚不完全清楚；本研究旨在通过分析美国肾脏数据系统的数据来评估这些因素。
分析了 2012 年 1 月 1 日至 2019 年 12 月 31 日期间死亡的美国肾脏数据系统中肾功能衰竭患者的数据。使用卡方检验和逻辑回归评估相关因素与结局之间的关系，使用 Joinpoint 回归分析趋势。
在 803049 名患者中，中位（IQR）年龄为 71（17）岁，57%为男性，27%登记了临终关怀，8%在没有登记临终关怀的情况下在死亡前停止透析，7%在临终关怀中停留了≥15 天。65 岁及以上的患者（调整后的优势比[aOR]：2.75，95%置信区间[CI]：2.71-2.79）和白人种族（aOR：1.79，95% CI：1.77-1.81）更有可能登记临终关怀。白人患者（aOR：0.75，95% CI：0.73-0.76）和从未接受过肾移植的患者（aOR：0.75，95% CI：0.73-0.78）接受临终关怀的时间更短。临终关怀登记和标准化临终关怀持续时间随着时间的推移而增加，年平均百分比变化分别为 1.1%（95% CI：0.6-1.6）和 5%（95% CI：2.6-7.4）。
2012 年至 2019 年间死亡的终末期肾病患者中，约每 4 人就有 1 人有临终关怀的历史，而每 12 人就有 1 人在没有临终关怀登记的情况下在死亡前停止透析。临终关怀的持续时间呈上升趋势。
