Patterns of kidney supportive care referrals in a tertiary hospital in India: a six-year audit

Patients with end-stage kidney disease (ESKD) and acute kidney injury on chronic kidney disease (AKI-on-CKD) experience significant symptom burden and high mortality, yet evidence for structured palliative integration within nephrology remains limited in low- and middle-income countries.

To describe the timing and reasons for referrals from Nephrology to Palliative Medicine, the interventions delivered, and clinical outcomes following referral.

A retrospective cohort study was conducted of all adult patients (n = 325) referred from Nephrology to Palliative Medicine. Data included demographics, renal diagnosis, dialysis modality, comorbidities, treatment intent, and documented palliative interventions, and were analyzed using descriptive statistics.

Mean age was 63.6 ± 14.1 years; 229 (70.5%) were male. Renal diagnoses comprised ESKD (215; 66.2%), AKI-on-CKD (86; 26.5%), and AKI (16; 4.9%). Dialysis modalities included maintenance hemodialysis (194, 59.7%), dialysis for AKI (63, 19.4%), and conservative kidney management (21, 6.5%). Referrals were primarily for GOC discussions (41.5%), followed by pain and symptom management (29.2%) and end-of-life (EOL) care (27.4%). Referrals specifically for conservative kidney management were uncommon (1.8%). Among deaths, 154 (75%) occurred in the hospital. Common triggers for referral included sepsis, multiorgan failure, and decisions to stop dialysis.

Palliative care involvement predominantly occurred during acute decline-often related to sepsis, multiorgan failure, or dialysis withdrawal. Although most patients died in the hospital, the high frequency of GOC and EOL discussions highlights the need for earlier, proactive palliative care engagement to support informed decision-making, symptom relief, and care aligned with patient preferences.