Current trends in hospice care usage for dialysis patients in the USA

BACKGROUND: The predictors and latest trends in hospice utilization, adequate duration of hospice care, and dialysis discontinuation without hospice enrollment among patients with end stage kidney disease are not fully known; the aim of this study was to assess them, analysing data from the United States Renal Data System. METHODS: Data from the United States Renal Data System for patients with kidney failure who died between January 1, 2012, and December 31, 2019, were analyzed. Chi-square and logistic regression were used to evaluate associations between outcomes of interest and predictors, while Joinpoint regression was used to examine trends. RESULTS: Among 803,049 patients, the median (IQR) age was 71 (17) years, 57% were male, 27% enrolled in hospice, 8% discontinued dialysis before death without hospice enrollment, and 7% remained in hospice for ≥ 15 days. Patients 65 years and older (adjusted odds ratio [aOR]: 2.75, 95% CI 2.71-2.79) and White race (aOR: 1.79, 95% CI 1.77-1.81) were more likely to enroll in hospice. White patients (aOR: 0.75, 95% CI 0.73-0.76) and those who never received a kidney transplant (aOR: 0.75, 95% CI 0.73-0.78) were less likely to have adequate duration of hospice care. Hospice enrollment and standardized duration of hospice care increased over time, with an average annual percentage change of 1.1% (95% CI 0.6-1.6) and 5% (95% CI 2.6-7.4), respectively. CONCLUSIONS: Approximately one in every four patients with kidney failure who died between 2012 and 2019 had a history of hospice enrollment, while one in every 12 discontinued dialysis before death without hospice enrollment. There was an upward trend in the duration of hospice care.