Palliative Care Interventions for Patients With Kidney Disease: A Scoping Review by the Kidney Disease Aging Research Collaborative

Background: Chronic Kidney Disease (CKD) impacts ~40% of US adults aged ≥ 60 years. Palliative care, which can improve symptoms of serious illness, is underutilized in CKD despite it's association with a high symptom burden. We conducted a scoping review of palliative care interventions in CKD, with particular attention to older adults. Methods: We searched PubMed, CINAHL, EMBASE, Cochrane Central, PsycInfo, ClinicalTrials.gov, and Web of Science for: (1) kidney disease; (2) palliative care; and (3) study design. Palliative care interventions were defined as medical strategies that address ≥ 1 domain of the Clinical Practice Guideline for Quality Palliative Care. We characterized studies, quantified palliative care domains assessed, summarized symptom and quality of life outcomes, and identified studies limited to older adults. Results: Of 2046 studies screened, 25 (1%) met inclusion criteria. Ten studies (40%) were randomized controlled designs. The most common quality domains addressed were physical aspects of care (21, 84%) and structure and processes of care (16, 64%). Twenty-four (96%) studies measured symptoms, 12 (48%) measured quality of life, and 11 (44%) measured both. Twenty-one different instruments were used to measure symptoms or quality of life. Six (24%) studies were limited to older adults. Conclusions: In our sample of studies evaluating CKD palliative care interventions, limited quality domains were addressed, a variety of measurement tools were used, and less than a quarter of studies were conducted only in older adults. Future research should address the holistic nature of palliative care, apply standardized instruments, and increase inclusion of older adults.