Acute kidney injury (AKI) is a frequent consequence of coronavirus disease 2019 (COVID-19) with a high fatality rate. Palliative care, a specialization that helps patients with terrible illnesses, was beneficial to these patients but had historically been underused in AKI. For a study, researchers sought to discuss the use of palliative care in patients with AKI and COVID-19 and their following use of health care. They performed a retrospective study of COVID-19 hospitalizations at New York University Langone Health between March 2, 2020, and August 25, 2020, using electronic health data from the hospital. The variables linked with palliative care consultation were investigated using regression models.
Even after controlling for markers of critical illness (admission to intensive care units, mechanical ventilation, etc.), patients with COVID-19 (n=4276; 40%) were more likely than those without COVID-19 (n=2966; 69%) to receive palliative care (AKI without KRT: adjusted odds ratio, 1.81; 95 CI%, 1.40 to 2.33; P<0.001; AKI with KRT: adjusted odds ratio, 2.45; 95% CI, 1.52-3.97; P<0.001). Similarly, 6% of KRT patients got palliative care, compared to 37% (P<0.001) of AKI patients who did not undergo KRT, and the time was likewise delayed (12 days versus 9 days; P=0.002). Despite receiving more palliative care, patients with AKI had considerably longer lengths of stay, more intensive care unit hospitalizations, and more mechanical ventilation. In addition, those with AKI had a greater rate of inpatient hospice discharge (6% against 3%) and a change in code status (34% versus 7%) than those without AKI.
Palliative care was used more frequently in patients with AKI and COVID-19 than had previously been documented in AKI patients. Despite the high death rate, consultation occurred late in the hospital course and was unrelated to a decrease at the beginning of life-sustaining treatments.