CURRENT TRENDS IN HOSPICE CARE USAGE FOR DIALYSIS PATIENTS IN THE USA

Abstract

ABSTRACTBackgroundThis study examined the predictors and latest trends in hospice utilization, adequate duration of hospice care, and dialysis discontinuation without hospice enrollment among patients with end stage renal disease (ESRD).MethodsData from the United States Renal Data System (USRDS) for ESRD patients 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.ResultsAmong 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 older than 64 years (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 (AAPC) of 1.1% (95% CI:0.6 – 1.6) and 5% (95% CI:2.6 – 7.4) respectively.ConclusionsApproximately one in every four ESRD patients 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 standardized duration of hospice care.