Palliative Care Rising For Inpatients

Palliative Care; Among patients with ESKD, transplantation is associated with longer survival, better quality of life, and cost savings compare with treatment with chronic dialysis. Remarkably, the benefits of transplantation are applicable to most patients with ESKD; also only a minority of patients with ESKD have absolute contraindications to transplantation such as active malignancy, uncontrolled infection, active substance abuse, or habitual nonadherence.

An insufficient supply of organs is the primary factor limiting treatment with transplantation; also patients routinely wait on dialysis for 5 or more years for a deceased donor transplant. Given these conditions, minimizing disparities in patient access to transplantation; which has been a challenge for transplant programs worldwide.

ESKD requiring maintenance dialysis

Implementation of scientifically grounded organ distribution policies on the basis of clinical criteria and ethical norms are essential features of national transplant systems to ensure fairness in access to transplantation among wait list patients.There was an increase in provision of palliative care for patients hospitalized between 2006 and 2014 with end-stage kidney disease (ESKD) requiring dialysis; but rates were lower for black and Hispanic patients; according to a study published online Aug. 6 in the Journal of the American Society of Nephrology.

To investigate the use of palliative care consultation in patients with ESKD; so in the inpatient setting; they conduct a retrospective cohort study using the National Inpatient Sample from 2006 to 2014 to identify admitted patients with ESKD requiring maintenance dialysis. They compare palliative care use among minority groups (black, Hispanic, and Asian); also white patients, adjusting for patient and hospital variables.

Yumeng Wen, M.D., from Mount Sinai St. Luke’s and Mount Sinai West Hospitals in New York City, and colleagues assess the use of palliative care consultation in patients with ESKD in the inpatient setting. The analysis examined racial differences in palliative care using the National Inpatient Sample (2006 to 2014) to identify 5,230,865 hospitalizations for patients with ESKD requiring maintenance dialysis.

Hospitalizations with palliative care

The researchers found that overall; 1.5% of the hospitalizations involved palliative care. During the study period; the palliative care referral rate increase significantly from 0.24% to 2.70%. However, black and Hispanic patients were significantly less likely than white patients; so to receive palliative care services (adjusted odds ratios, 0.72 for blacks and 0.46 for Hispanics). These disparities were consistent across all hospital subtypes; including those serving higher proportions of minorities.

Palliative care was also less likely among minority patients with lower socioeconomic status; so (both those with a lower level of income and nonprivate health insurance). “Further investigation into causes of racial and ethnic disparities is necessary to improve access to palliative care services for the vulnerable ESKD population,” the authors write. Two authors disclose financial ties to the pharmaceutical industry.

Despite a clear increase during the study period in provision of palliative care for inpatients with ESKD; significant racial disparities occurred and persisted across all hospital subtypes. Further investigation into causes of racial and ethnic disparities is necessary to improve access to palliative care services for the vulnerable ESKD population.