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Kidney failure end-of-life care: impact of advance care planning – retrospective observational study
  1. Kelly Chenlei Li1,2,
  2. Frank Brennan2 and
  3. Mark A Brown1,2
  1. 1 School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Renal Department, St George Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Kelly Chenlei Li, University of New South Wales, Sydney, NSW 2052, Australia; ChenleiKelly.Li{at}


Objectives Patients with kidney failure (KF) have poor prognosis yet receive aggressive medical interventions at the end of life. Advance care planning (ACP) aims to respect patients’ treatment preference and facilitate good death, though whether these are achieved in KF is unknown.

This study examines the utility of ACP for end-of-life care in KF patients.

Methods A retrospective observational study of KF patients who completed an ACP document 2012–2019 and died in an Australian hospital. Medical records were reviewed to assess treatment concordance to the ACP document and quality of end-of-life care received.

Results 65 KF patients (29 dialysis, 36 conservative) had a median age of 84 years and 57% males. 86% of deaths followed an emergency admission. ACP documents recorded patients’ preference to avoid cardiopulmonary resuscitation (91%) and forego dialysis (86%). 95% patients received treatment concordant with ACP. One patient was resuscitated, and one conservative patient dialysed. A good quality death was achieved for most, including dialysis withdrawal (80%), palliative care referral (88%), discussion of prognosis (95%), rationalised medications (89%) and anticipatory end-of-life medications (92%).

Conclusion ACP documents are useful facilitating treatment concordant with KF patients’ preferences. Most patients avoided aggressive medical interventions and received good quality end-of-life care.

  • Chronic conditions
  • Clinical decisions
  • Renal failure
  • Supportive care
  • Terminal care

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  • Contributors KCL and MAB conceived and reviewed study protocol. KCL collected and analysed the study data, and wrote the manuscript. FB cared for study participants. KCL, FB and MAB critically reviewed the manuscript and provided feedback. KCL is guarantor for this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.