title: The use of palliative care services amongst end-stage kidney disease patients in an Irish tertiary referral centre.
abstract: BACKGROUND
  Although patients with end-stage kidney disease (ESKD) have a shortened life expectancy, their end-of-life (EOL) care is suboptimal. The aim of this study was to review the utilization of specialist palliative care (SPC) in patients with ESKD in Dublin, Ireland.
  
  
  METHODS
  We conducted a retrospective chart review of prevalent patients with ESKD who died between January 2005 and December 2009 at a tertiary referral centre. We recorded SPC referrals, modality of renal replacement therapy, age and place of death.
  
  
  RESULTS
  Of 131 included patients, 88 (67.2%) were male, mean age at death was 63.2 ± 15.1 years and 102 (77.9%) were treated with haemodialysis. Forty-eight patients (36.7%) were referred to SPC, who were involved in the patients' management for a median of 12 days (range 0-907) before death. A total 104 patients (79.4%) died in an acute hospital, 19 (14.5%) died at home, 3 (2.3%) died in an inpatient hospice and the place of death was unknown for 5 patients (3.8%). Dialysis was withdrawn prior to death in 50 patients (38.1%), with a median time to death after withdrawal of dialysis of 6 days (0-105 days). A discussion regarding the withdrawal of dialysis was more frequently held with family member(s) rather than the patient.
  
  
  CONCLUSIONS
  SPC was involved in the antemortem care of ∼1/3 of the patients with the majority of referrals placed at a late stage. Given the short timeframe until death once dialysis is withdrawn, it is imperative that appropriate EOL care is instituted. This study identifies an underutilization of SPC and improved integration of palliative care and nephrology services may optimize EOL care for patients with ESKD.
authors.affiliation: Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland.
authors.forename: Lynn
authors.initials: L
authors.lastname: Redahan
authors.affiliation: Department of Palliative Care Medicine , AMNCH, Tallaght , Dublin , Ireland.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Brady
authors.affiliation: Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smyth
authors.affiliation: Department of Palliative Care Medicine , AMNCH, Tallaght , Dublin , Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Higgins
authors.affiliation: Department of Nephrology , AMNCH, Tallaght , Dublin , Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wall
keywords: dialysis; end-of-life care; end-stage kidney disease; palliative care; withdrawal of dialysis