Care for elderly dialysis patients at the end of life is challenging, presenting ethical, legal, medical, and pyschosocial dilemmas. Clinical practice guidelines have been developed in the United Kingdom and the United States to give direction to the nephrology team in providing end-of-life care to patients on dialysis. All these guidelines promote the involvement of palliative care, especially for patients who withdraw from dialysis. We have previously published study results on general outcomes for a cohort of elderly patients starting dialysis. The aim of this project was to examine the effect of palliative care services on the end-of-life care of elderly patients on dialysis.

We conducted a retrospective cohort study (2000-2005) of all patients 80 years and older who had started dialysis at our regional dialysis program. Our cohort included 105 patients: 50 percent were women and the median age was 84.5 years (range 80-95 years). Over the study period 59 patients died while still on our program. Of these 59 patients, 27 (46%) had received a palliative care consult. In the palliative consult group, all patients had a do not resuscitate (DNR) order in place, 22 (81%) were prescribed medications for pain in the 24 hours before death, and 19 (70%) withdrew from dialysis before death. Patients received the palliative care consult a median of 6 days (range 1-110 days) before death.