Hospice Among Hemodialysis Patients: Too Little, Too Late to Impact Care Delivery or Costs?

Patients with end-stage renal disease (ESRD) have high symptom burden1,2 and high risk for mortality.3 The 5-year survival rate for patients starting hemodialysis therapy in 2010 was 42%, lower than survival with many forms of cancer.4 Despite these realities, patients with ESRD receive more aggressive treatment at the end of life than patients with other life-limiting conditions. In a recent retrospective study of 57,753 decedents in the Veterans Affairs system, 32.3% of patients with ESRD died in an intensive care unit (ICU), compared to 13.4% of patients with cancer and 8.9% of patients with dementia.

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