ArticleCanadian family physician Medecin de famille canadien2025
Older adults with advanced chronic kidney disease and access to palliative care: Retrospective cohort study in primary care.
Article in Canadian family physician Medecin de famille canadien, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Access to specialist palliative care and health care service utilization during the final year of life among patients with kidney disease.Clinical kidney journal · 2026Article
- A field guide to aging.Canadian family physician Medecin de famille canadien · 2025Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo describe the provision of primary and specialist palliative care for older adults with advanced chronic kidney disease (CKD).
designPopulation-based retrospective descriptive cohort study using electronic health records.
settingSt Michael's Hospital Academic Family Health Team, including 5 clinics and an interdisciplinary home-based outreach team, in Toronto, Ont.
participantsOlder adults who are 65 years of age or older with advanced CKD and undergoing community-based nondialysis kidney care between April 1, 2012, and April 1, 2022, with at least 1 year of follow-up.
main outcome measuresPrevalence of advance care planning, goals of care (GOC) discussions, access to specialized palliative care, frequency of hospitalizations, places of deaths, and mean survival time.
resultsThe study included 47 older adults with advanced CKD who were not undergoing dialysis and receiving primary care. Sixty-eight percent were female (n=32), and the mean (SD) age was 81 (8) years. The mean (SD) number of comorbidities was 5 (2). Almost half of the patients (n=22) lived alone. Seventy percent of the cohort (n=33) had a documented substitute decision maker. Approximately one-third of the cohort (n=16) had GOC conversations involving prognosis, hospital transfer, place of death, and treatment goals. Forty-seven percent (n=22) accessed specialist palliative care during follow-up. Seventy-four percent (n=35) had 1 or more hospitalization. Thirty-two percent (n=8) died at home. The mean (SD) survival time was 2 (2) years.
conclusionA palliative approach to care including advance care planning and GOC conversations would be appropriate for older adults with advanced CKD given their high rates of comorbidities, hospitalizations, and mortality. Primary care providers might experience challenges facilitating conversations in this population, highlighting opportunities for enhanced training and point-of-care interventions, and facilitating access to specialist palliative care consultations when appropriate.
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