Is Palliative Care Useful for COVID-19 Patients With Acute Kidney Injury?

Palliative care used for hospitalized patients with acute kidney injury (AKI) and COVID-19 was not associated with reduced initiation of life-sustaining interventions.

The use of palliative care in COVID-19 patients and acute kidney injury has been examined by a new study published in CJASN. Acute kidney injury (AKI) is a common complication of COVID-19 and is associated with a higher risk of death.

Palliative care focuses on providing relief from the symptoms and stress of a serious illness. Unfortunately, patients with AKI often do not receive palliative care, but studies have not analyzed the use of palliative care for hospitalized patients with both AKI and COVID-19.

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Acute renal failure is the sudden cessation of the functioning of kidneys, that can be due to reduced renal blood flow, damage to renal tissues.

‘Palliative care was often called later for COVID-19 patients with acute kidney injury in the hospital despite having such high mortality.’

To investigate, researchers conducted a retrospective analysis of New York University Langone Health’s electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020.

These data pertained to three acute care hospitals located in Manhattan, Brooklyn, and Long Island. Of 4,276 patients with COVID-19, 1,310 (31%) developed AKI.

Compared with those without AKI, individuals with AKI received more palliative care consults (42% vs. 7%), but they occurred significantly later (10 days from hospital admission vs. 5 days).

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Those with AKI had 1.81 times higher odds of receiving palliative care than those without AKI, even after controlling for markers of critical illness (such as admission to intensive care units or the use of mechanical ventilation).

66% of patients with AKI who initiated kidney replacement therapy (KRT) such as dialysis received palliative care vs. 37% of those with AKI not receiving KRT.

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Palliative care consults also occurred later for those who were started on KRT compared with those who were not (12 days from admission vs. 9 days).

Despite greater use of palliative care, patients with AKI had a significantly longer length of hospital stay, more intensive care unit admissions, and more use of mechanical ventilation.

Quiz on Kidney
The kidneys are two bean-shaped organs, each about the size of a fist, and are located just below the rib cage, one on each side of your spine.

Healthy kidneys filter about half a cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. The bladder stores urine. The kidneys, ureters, and bladder are partof the urinary tract.

kidneys remove wastes and extra fluid from your body. Kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals-such as sodium, calcium, phosphorus and potassium-in your blood ().

Without this balance, nerves, muscles, and other tissues in the body may not work normally.

Kidneys also make hormones that help

Control your blood pressure
Make red blood cells
Keep your bones strong and healthy

Compared with those without AKI, a higher proportion of those with AKI died during hospitalization (46% vs. 5%) or were discharged to inpatient hospice (6% vs. 3%), while a lower proportion was discharged home (24% vs. 77%).

However, given the high mortality, it does suggest that patients and families could have benefited from earlier support from palliative care.

Palliative care supports primary doctors in caring for seriously ill patients by managing emotional and physical symptoms while also assisting in advance care planning. Importantly, it can be incorporated into the care plan of someone who is pursuing curative care and can be helpful in an acute and possibly reversible situation.

Source-Medindia