End-of-life of conservative kidney management in older CKD patients undergoing comprehensive geriatric assessment.

BACKGROUND

Many older chronic kidney disease (CKD) patients with frailty do not tolerate renal replacement therapy (RRT). Although conservative kidney management (CKM) has become popular in Europe and America, end-of-life care systems, including palliative care intervention methods, have not been established.

METHODS

We analyzed a total of 20 CKD patients aged 65 years or older who underwent comprehensive geriatric assessment (CGA), selected CKM based on advanced care planning (ACP), and died of end-stage renal disease.

RESULTS

The mean age at death was 87.4 years. At the time of the CKM decision, BUN was 85.6 mg/dL, Cre was 5.2 mg/dL, eGFR was 10.9, clinical frailty scale (CFS) was 6.4, dementia assessment sheet for community-based care systems (DASC-21) was 55.6, and time from decision to death was 88 days. Eleven patients required sedatives for delirium and eight patients required narcotics for dyspnea or pain. Patients who required sedation were younger, had lower DASC-21, and were significantly more likely to have cardiovascular disease and diabetes than those who did not. Patients who required narcotics were younger, had lower CFS, and were significantly more likely to have cardiovascular disease than those who did not require narcotics.

CONCLUSIONS

ESRD patients who opted for CKM requiring palliative care narcotic or sedative intervention were characterized by young older patients with less dementia and frailty and those with cardiovascular disease. This study shows predictors of the need for palliative treatment at the end of life for CKM, which could be useful information for improving end-of-life care for CKM.