Gayathri M Surya, Naik Bharathi, Ghoshal Arun, Damani Anuja, Nagaraju Shankar Prasad
Department of Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Department of Nephrology, Father Muller College of Allied Health Science, Kankanady, Mangalore, India.
BMC Palliat Care. 2025 Apr 21;24(1):107. doi: 10.1186/s12904-025-01748-9.
End-stage kidney disease (ESKD) significantly burdens healthcare systems and increases mortality. In India, approximately 175,000 individuals are relying on maintenance hemodialysis (mHD). This study aims to analyze the place of death, mortality patterns and clinical issues surrounding death in patients with ESKD undergoing mHD at a tertiary care hospital in south India.
This retrospective study reviewed the medical records of 280 patients with ESKD who underwent mHD between January 2016 and April 2022. Data were collected on demographics, financial details, comorbidities, cause of death, clinical issues, and location of death. Descriptive statistics, including means, frequencies, and proportions, were used to summarize findings.
Among the 280 patients on mHD, there were 98 deaths. Of these, 73.5% died in hospitals, primarily in intensive care units. Of all the patient deaths, 57.7% patients who died at home and 41.6% of hospitalized patients paid out of pocket treatment expenses. Infections and cardiovascular complications were the leading causes of death. High comorbidity and symptom burden were reported, with edema, fatigue, and breathlessness being the most common symptoms. Among the hospital deaths, withholding or withdrawing life sustaining treatments was documented in only 22.2% of cases.
Our study provides critical insights into mortality patterns and the need for improved kidney supportive care integration in patients with ESKD. Addressing symptom burden, enhancing ACP, and implementing end of life care protocols could align healthcare delivery with patient preferences, ultimately improving the quality of end of life care in this vulnerable population. Further research is recommended to explore broader interventions and their impact on patient outcomes.
终末期肾病（ESKD）给医疗系统带来了沉重负担，并增加了死亡率。在印度，约有17.5万人依赖维持性血液透析（mHD）。本研究旨在分析印度南部一家三级护理医院中接受mHD的ESKD患者的死亡地点、死亡模式以及围绕死亡的临床问题。
这项回顾性研究回顾了2016年1月至2022年4月期间接受mHD的280例ESKD患者的病历。收集了有关人口统计学、财务细节、合并症、死亡原因、临床问题和死亡地点的数据。使用描述性统计，包括均值、频率和比例，来总结研究结果。
在280例接受mHD的患者中，有98例死亡。其中，73.5%在医院死亡，主要在重症监护病房。在所有患者死亡中，57.7%在家中死亡的患者和41.6%住院患者的治疗费用是自掏腰包。感染和心血管并发症是主要死因。报告显示合并症和症状负担较高，水肿、疲劳和呼吸急促是最常见的症状。在医院死亡病例中，只有22.2%的病例记录了停止或撤回维持生命的治疗。
我们的研究为ESKD患者的死亡模式以及改善肾脏支持性护理整合的必要性提供了重要见解。解决症状负担、加强预立医疗照护规划（ACP）并实施临终护理方案可以使医疗服务与患者偏好保持一致，最终改善这一弱势群体的临终护理质量。建议进一步开展研究，以探索更广泛的干预措施及其对患者结局的影响。
