Category(s):
Health
Status: Active
Principal: Daniel Dutton
Project Number: P0134
Year Approved: 2024
Haemodialysis (HD), a life-sustaining therapy for those with end-stage kidney disease (ESKD), was once offered only to “suitable” patients; often younger patients with minimal comorbidities. As universal access to dialysis has become entrenched in Canadian society, HD patients are older, more comorbid, and present in higher numbers than ever before. The expected impact of dialysis on longevity and quality of life in older patients is poorly understood, especially in Atlantic Canada.
These impacts are critical to understand for older patients to participate in a shared model of decision-making regarding dialysis as a care option. This is true for both patients and health care practitioners alike. Shared decision processes require educated and experienced health care professionals who understand evidence-based information about available treatment options and their expected outcomes. Patients have specific values and preferences that help frame their ideas about pursing proposed treatments.
The shared decision to initiate dialysis, a life-sustaining and often life-long therapy, is incredibly complex and is hampered by the lack of data on the expected impacts of this therapy. Current estimates from the United States Renal Data Systems suggests the 1-year mortality rate for patients starting dialysis after the age of 65.5yrs is 54.5%. Higher mortality has been associated with more advanced age. Data on the impact of quality-of-life, health care utilization and costs are limited and has not been compared across age cohorts. In addition to patients and health care professionals, health policy makers also need to understand the implications of dialysis initiation particularly for older patients in which demands on the health care system may be significant and include hospitalizations, emergency room visits, surgical interventions, and overall costs.
The proposed project will track health care system use of multiple cohorts of patients starting on dialysis stratified by age (e.g., 60 to 69, 70 to 79, and 80+). Administrative data will be used to compare health care utilization and health outcomes between age stratified patient cohorts. We propose tracking patient health care use and health outcomes (including surgical interventions, hospitalizations, mortality, and emergency room use) and apply cost estimates to that use from the literature. End of life care including death in hospital, hospitalization in the last month of life will be examined.
