Access to specialist palliative care and health care service utilization during the final year of life among patients with kidney disease

Background

Despite the heavy symptom burden and progressive nature of non-malignant kidney diseases, access to palliative care services may be limited. We evaluated access to specialist palliative care (SPC), and its effect on health care utilization among patients with non-malignant and malignant kidney disease during their final year of life.

Methods

This retrospective cohort study examined causes of death among ≥18-year-old individuals in Finland in 2019 using the National Causes of Death Register. Data on access to SPC, emergency department contacts, and hospitalizations were collected from the National Care Register for the final year of life.

Results

Five hundred eighty-five patients had non-malignant kidney disease (54.8% females, mean age 84 years at the time of death) and 706 patients had malignant kidney disease (35.3%, 77.2 years, respectively). Of the patients with non-malignant kidney disease, only 54 (9.1%) had access to SPC services compared to 195 (27.6%) with malignant kidney disease (P < .001). Within patients with malignant kidney disease, those who had access to SPC died at home more often (10.6% vs. 5.9%; P = .049), had fewer emergency department contacts (19.7% vs. 32.9%), and had a lower proportion of hospitalizations (16.4% vs. 37.2%; P < .001) and readmissions to secondary care (4.6% vs. 10.6%; P = .025) when compared to those without SPC access. No difference with regard to SPC access was seen among patients with non-malignant kidney disease.

Conclusion

While SPC demonstrated benefits in malignant kidney disease patients’ health care utilization, access was markedly limited for patients with non-malignant conditions, underscoring the need for improvements in service provision.