End-of-Life Experience of Older Adults Dying of End-Stage Renal Disease: A Comparison With Cancer

J Pain Symptom Manage. 2017 Dec;54(6):789-797. doi: 10.1016/j.jpainsymman.2017.08.013. Epub 2017 Aug 24.


Context: Older adults with end-stage renal disease (ESRD) are a rapidly growing group of seriously ill patients. Yet, despite a mortality rate almost twice that of cancer, less is known about the impact of ESRD on patients' end-of-life experience.

Objective: To compare the end-of-life experience of older adults who died of ESRD vs. cancer.

Methods: We used data from the Health and Retirement Study, a nationally representative survey of older adults. Our sample included 1883 Health and Retirement Study participants who died of cancer or ESRD between 2000 and 2010 and their family respondents. We compared advance care planning, treatment intensity, and symptoms between the two groups and used propensity score weighting to adjust for differences by diagnosis.

Results: Among propensity-weighted cohorts, older adults with ESRD, compared with similar patients with cancer, were less likely to have end-of-life instructions (adjusted proportions 38.5% vs. 49.7%; P = 0.005) and were more likely to die in the hospital (53.5% vs. 29.0%; P < 0.001) and to use the intensive care unit in the last two years of life (57.1% vs. 37.0%; P < 0.001). Decedents with ESRD and cancer had similarly high rates of moderate or severe pain (53.7% vs. 57.8%; P = 0.34) and all other symptoms.

Conclusion: Older adults dying of ESRD had lower rates of advance care planning and higher treatment intensity near the end of life than similar patients dying of cancer; both groups had similarly high rates of symptoms. Efforts are needed to make treatment more supportive and alleviate suffering for older adults with ESRD and their families near the end of life.

Keywords: End-stage renal disease; Health and Retirement Study; end-of-life care; symptom burden; treatment decision making.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Advance Care Planning
  • Aged
  • Aged, 80 and over
  • Cost of Illness
  • Family
  • Female
  • Humans
  • Interviews as Topic
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Neoplasms / mortality
  • Neoplasms / therapy*
  • Pain / epidemiology
  • Propensity Score
  • Socioeconomic Factors
  • Terminal Care*