(HealthDay News) — More intensive patterns of end-of-life care are associated with lower family ratings of quality of care among patients with advanced chronic kidney disease (CKD), according to a study published online in the Clinical Journal of the American Society of Nephrology.

Claire A. Richards, PhD, RN, from the Veterans Affairs Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, and colleagues designed a retrospective study among a national cohort of 9993 veterans with advanced CKD who died between 2009 and 2015.

The researchers found that 55, 12, and 34% of patients did not receive dialysis, received acute dialysis, and received maintenance dialysis, respectively. More intensive patterns of end-of-life care were seen for patients treated with acute or maintenance dialysis versus those not treated with dialysis. Lower overall family ratings of end-of-life care were seen with receipt of maintenance dialysis and more intensive patterns of end-of-life care after adjustment for patient and facility characteristics, while higher overall ratings were seen in association with receipt of palliative care and hospital services. After additional adjustment for end-of-life treatment patterns, the correlation between maintenance dialysis and overall quality of care was attenuated.

“A deeper understanding of what drives both patterns and quality of end-of-life care among patients with advanced CKD may help to identify opportunities to improve care for members of this population,” the authors write.

One author disclosed financial ties to the medical technology and kidney dialysis industries.

Reference

Richards CA, Liu CF, Hebert PL, et al. Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD. Clin J Am Soc Nephrol. August 2019, CJN.01560219. doi:10.2215/CJN.01560219