Evidence map›Paper›PMID 27693262›Full record

ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2017

Trends in Receipt of Intensive Procedures at the End of Life Among Patients Treated With Maintenance Dialysis.

Nwamaka D Eneanya, Susan M Hailpern, Ann M O'Hare, Manjula Kurella Tamura, Ronit Katz, William Kreuter, Maria E Montez-Rath, Paul L Hebert, Yoshio N Hall

Abstract read
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In one paragraph

Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Trial
  2. Article
  3. Observational
  4. Article
  5. Article
  6. Race, Ethnicity, and End-of-Life Care in Dialysis Patients in the United States.Journal of the American Society of Nephrology : JASN · 2018
    Article
  7. Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2018
    Review
  8. Racial Disparities in Hospice Outcomes: A Race or Hospice-Level Effect?Journal of the American Geriatrics Society · 2018
    Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Nwamaka D EneanyaDivision of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: aeneanya@partners.org.
Susan M HailpernDivision of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA.
Ann M O'HareDivision of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA; Hospital and Specialty Medicine, Veteran Affairs Puget Sound Health Care System, Seattle, WA; Group Health Research Institute, Seattle, WA.
Manjula Kurella TamuraGeriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA.
Ronit KatzDivision of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA.
William KreuterDivision of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA.
Maria E Montez-RathDivision of Nephrology, Stanford University School of Medicine, Palo Alto, CA.
Paul L HebertSeattle-Denver Center of Innovation, Veterans Affairs Puget Sound Healthcare System, Seattle, WA.
Yoshio N HallDivision of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA.

Funding

USRDS Special Study Center on Palliative and End-of-Life CareU01DK102150 · NIDDK · UNIVERSITY OF WASHINGTON · PI KURELLA TAMURA, MANJULA, O'HARE, ANN M. · 2014 to 2018
$2.6M
Patient Oriented Studies of Vitamin D in Chronic Kidney DiseaseK24DK094872 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI THADHANI, RAVI · 2012 to 2016
$546k
NIDDK NIH HHS K24 DK094872NIDDK NIH HHS U01 DK102150NIMHD NIH HHS L60 MD010141
6 · The paper itself

Abstract

backgroundMany dialysis patients receive intensive procedures intended to prolong life at the very end of life. However, little is known about trends over time in the use of these procedures. We describe temporal trends in receipt of inpatient intensive procedures during the last 6 months of life among patients treated with maintenance dialysis. STUDY

designMortality follow-back study. SETTING &

participants649,607 adult Medicare beneficiaries on maintenance dialysis therapy who died in 2000 to 2012. PREDICTORS: Period of death (2000-2003, 2004-2008, or 2009-2012), age at time of death (18-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥85 years), and race/ethnicity (Hispanic, non-Hispanic black, or non-Hispanic white). OUTCOME: Receipt of an inpatient intensive procedure (defined as invasive mechanical ventilation/intubation, tracheostomy, gastrostomy/jejunostomy tube insertion, enteral or parenteral nutrition, or cardiopulmonary resuscitation) during the last 6 months of life.

resultsOverall, 34% of cohort patients received an intensive procedure in the last 6 months of life, increasing from 29% in 2000 to 36% in 2012 (with 2000-2003 as the referent category; adjusted risk ratios [RRs] were 1.06 [95% CI, 1.05-1.07] and 1.10 [95% CI, 1.09-1.12] for 2004-2008 and 2009-2012, respectively). Use of intensive procedures increased more markedly over time in younger versus older patients (comparing 2009-2012 to 2000-2003, adjusted RR was 1.18 [95% CI, 1.15-1.20] for the youngest age group as opposed to 1.00 [95% CI, 0.96-1.04] for the oldest group). Comparing 2009 to 2012 to 2000 to 2003, the use of intensive procedures increased more dramatically for Hispanic patients than for non-Hispanic black or non-Hispanic white patients (adjusted RRs of 1.18 [95% CI, 1.14-1.22], 1.09 [95% CI, 1.07-1.11], and 1.10 [95% CI, 1.08-1.12], respectively). LIMITATIONS: Data sources do not provide insight into reasons for observed trends in the use of intensive procedures.

conclusionsAmong patients treated with maintenance dialysis, there is a trend toward more frequent use of intensive procedures at the end of life, especially in younger patients and those of Hispanic ethnicity.

Indexed as

Renal DialysisAdolescentAdultAgedAged, 80 and overBlack or African AmericanFemaleHispanic or LatinoHumansKidney Failure, ChronicMaleMiddle AgedTerminal CareTime FactorsWhite PeopleYoung Adultage differencesdialysiselderlyEnd-of-lifeend-stage renal disease (ESRD)ethnic disparitieshealth care costsHispanichospitalizationintensive proceduresMedicare spendingmortality follow-back

Identifiers

PMID27693262
PMCPMC5182121

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.