title: Access to and characteristics of palliative care-related hospitalization in the management of end-stage renal disease patients on renal replacement therapy in France.
abstract: OBJECTIVE
  Palliative care is seldom proposed to patients with end-stage renal disease (ESRD) despite a mortality rate and disease burden as high as among cancer patients. The aim of this study is to analyze the access of palliative care-related hospitalization in the management of patients on dialysis in France, by describing the characteristics of these hospitalizations, the clinical status of the concerned patients, and the use of palliative care in those stopping dialysis.
  
  
  METHODS
  The French Renal Epidemiology and Information Network (REIN) registry includes data about 51 834 patients aged 20 years and older who began dialysis from 1 January 2008 to 31 December 2013, and were followed longitudinally until that date. Linkage to the anonymized national hospital discharge database allowed us to analyse hospitalizations associated with palliative care.
  
  
  RESULTS
  During the follow-up period, 1865 patients (3.6%) had a palliative care-related hospitalization corresponding to a total of 3382 hospitalizations. Lower levels of serum albumin, active cancer, and impaired mobility were each independently associated with the probability of at least one such hospitalization. During the same period 4540 patients withdrew from dialysis (9% of the patients), 10% of them had a palliative care-related hospitalization.
  
  
  CONCLUSIONS
  This study suggests that among ESRD patients, only a few resorted to palliative care-related hospitalization, even those withdrawing from dialysis. Cooperation between nephrologists and physicians trained in palliative care should be improved at least to the extent necessary to identify patients who should be referred to palliative care. Our study also highlights the need for more information on the current access to any kind of supportive care for dialysis patients.
authors.affiliation: REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: Nephrology Unit, University Hospital, Toulouse, France.
authors.forename: Del Bello
authors.initials: DB
authors.lastname: Arnaud
authors.affiliation: Nephrology Unit, University Hospital, Caen, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
authors.affiliation: Palliative Unit, University Hospital Caremeau, Nimes, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Blanchard
authors.affiliation: Nephrology - Internal Medicine Unit, Groupe hospitalier de la region Mulhouse et Sud Alsace, Mulhouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Chantrel
authors.affiliation: Nephrology Unit, University Hospital, Grenoble, France.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Maurizi-Balzan
authors.affiliation: Nephrology -Dialysis Unit, University Hospital Caremeau, Nimes, France.|Biostatistics, Epidemiology and Public Health, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012042:Registries; D017582:Renal Replacement Therapy; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult
keywords: cancer; death; dialysis withdrawal; end-stage renal disease; palliative care