[End-of-life in dialysis patients: an epidemiological study in the Lazio Region (Central Italy)]

to investigate the care pathway of dialysis patients in the final stages of life and to identify possible predictors of the interruption of dialysis treatment.

cohort study.

the study used data from the Regional Dialysis and Transplantation Registry of Lazio Region, along with data from the Lazio Health Information Systems. The study included haemodialysis patients who died between 2009 and 2022, residing of Lazio, and on dialysis for at least 6 months.

using descriptive statistical analysis and both unadjusted and adjusted logistic regression models, the interruption of dialysis treatment (defined as suspension for at least 7 days before death), and the possible predictors of this interruption were analysed.

the final cohort included 6,247 patients, of whom 1,009 (16.2%) interrupted dialysis treatment. The main causes of death include cardiac diseases, cachexia, and infections. The average age of the patients was 76.1 years (10.1 standard deviation); 65.2% were male. Multiple regression analysis identified the number of hospitalizations in the year prior to death (OR: 2.34; 95%CI 1.84-2.97), dialysis vintage (OR 0.80; 95%CI 0.66-0.96), and the presence of non-uremic anaemia (OR 1.46; 95%CI 1.06-2.00) as potential predictors of treatment interruption. Finally, a North-South gradient appears to exist by province of residence, with a higher likelihood of the final stages of life recognition in the province of Viterbo and a lower one in the province of Frosinone.

this study represents the first attempt in Italy, based oh health infromation sistems, to explore end-of-life care in haemodialysis patients, revealing insufficient recognition of end-of-life stages, leading to the continuation of dialysis treatment close to death. These data suggest an excessive medicalization of the end of life and a risk of inappropriate treatments. The introduction of advanced care planning documents, improved training for nephrologists, and the creation of multidisciplinary teams with palliative care specialists could improve patients' quality of life and optimize the use of healthcare resources.