More research examining palliative care in patients with allograft failure needed
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In a letter to the editors of Kidney Medicine, the team of researchers who created KidneyPal called for more research evaluating palliative care in transplant patients with allograft failure.
Further, researchers identified a trend of increased palliative care consultations following the introduction of KidneyPal in the kidney care community.
“While kidney palliative care is growing, patients with kidney failure tend to receive palliative care less frequently than other seriously ill patients, especially after transplantation. The utility of kidney palliative care for patients with allograft failure has not been well delineated,” Naoka Murakami, MD, PhD, from the division of renal medicine in the department of medicine at Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues wrote. “KidneyPal resulted from a systematic needs assessment about what kind of additional palliative care support was most needed in our hospital system. It is an interprofessional team consisting of a nurse practitioner, a social worker, and physicians boarded in hospice and palliative medicine who aligned with nephrology providers and sees patients with kidney diseases.”
In a cross-sectional study, Murakami and colleagues analyzed the frequency of inpatient palliative care consultation for adult patients who received post-kidney transplant care and experienced allograft failure before and after the creation of KidneyPal.
Researchers used a retrospective chart review of 2 years before and after KidneyPal was introduced in 2019. The analysis included 54 patients before KidneyPal was offered and 59 patients after the introduction of KidneyPal.
Inpatient palliative consultation frequency was not significantly different between the 40% of patients who later died with a functioning allograft before the creation of KidneyPal and the 33% died after KidneyPal. Similarly, death in hospice increased from 7% to 15% after KidneyPal.
Palliative care consultation increased from 5.9% to 24.1% for patients with allograft failure after the creation of KidneyPal, and KidneyPal clinicians discussed treatment options for allograft failure twice as much as general palliative care clinicians. Following the creation of KidneyPal, 17% of patients chose dialysis as a time-limited trial or opted for hospice or comfort-focused care in the hospital vs. the 3% of patients who made this choice prior to KidneyPal.
“In conclusion, studies on the care of patients with a failing allograft are limited, and more studies are needed to help meet their complex needs,” Murakami and colleagues wrote. “Discussing prognosis, goals of care, and treatment options with attention to physical and psychosocial symptoms after graft failure may be enhanced by collaboration with an interprofessional specialty kidney palliative care team.”
According to the researchers, limitations of this study include selection bias of patients referred to KidneyPal.
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