Family Feedback Survey on Quality of Dialysis Withdrawal and End-of-Life Care in Haemodialysis Patients in Intensive Care.

Abstract

Objectives: For end-stage kidney disease (ESKD) patients on maintenance haemodialysis (MHD), end-of-life care (EOLC) and dialysis discontinuation are established in Western nations, but family perspectives in the intensive care unit (ICU) remain understudied in developing nations like India. This study examined families' perceptions of EOLC, dialysis withdrawal and life-sustaining drug discontinuation for MHD patients in our ICU, where the Kidney Supportive Care (KSC) team was part of the Primary Medical Board (PMB).

Materials and methods: A cross-sectional survey examined family input for MHD ICU patients undergoing EOLC and dialysis discontinuation assisted by KSC team (palliative care expert, nephrologist and intensivist). We gathered baseline data, ICU admission causes, 24 h pre-death symptoms and withdrawal advice and used Statistical Package for the Social Sciences 21 for statistical analysis.

Results: 23/98 MHD patients (82.6% male, mean age 57 ± 12.09 years) underwent EOLC. ICU admissions were mostly for infection (47.8%). The most prevalent pre-death symptom was agitation (86.9%). Haemodynamic decline (82.6%) and disease progression (69.5%) drove withdrawal. All patients underwent dialysis withdrawal and had 'Do Not Resuscitate orders instituted. The rate of ventilator and inotrope withdrawal was 80% and 50%, respectively. 74% of families attended, and 20% received spiritual leader visits during EOLC. All participating family members reported no guilt and provided positive feedback for KSC team engagement during EOLC.

Conclusion: Our study highlights complete agreement of families on dialysis withdrawal and providing EOLC support in our ICU setting for ESKD patients. It also emphasises the need for a dedicated PMB with the KSC team for a better EOLC, which provides family satisfaction and avoids redundant interventions.