A retrospective study on the current status of palliative care for patients who have chronic kidney failure in Japan: analysis of big data of the national insurance system

Under the current Japanese health insurance system, patients with malignancy and severe heart failure are provided coverage for palliative care. Moreover, little is known about the comorbidities in the chronic kidney failure (CKF) patients. The National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which includes data on most Japanese insurance practices contains the digital data not only comorbidities, but also related to palliative care, i.e. advance care planning (home care, use of emergency room, intensive care, life-prolonging treatment) and opioid use. Thus, we aimed to investigate the status of palliative care for patients with CKF in Japan by analysis of NDB data. We assessed data on deaths in 2019 with CKF listed in the injury/illness record of the NDB. Practice codes related to age groups in five-year increments, gender, disease titles, use of opioids within one month before death, use of the emergency services, invasive and life-prolonging treatment, home care, and place of death were investigated. Data of a total of 70269 patients (5.1% of all deaths in 2019) were included. The comorbidities included malignancy (25.6%) and heart failure (25.5%). Oxycodone accounted for 68.3% of the oral opioids, whereas morphine accounted for 59.4% of the injectable opioids. The proportion of codes related to emergency care did not differ significantly between age groups. The proportion of codes related to lifesaving measures decreased linearly with age. Although the proportion of codes for home care and end-of-life care at home increased exponentially with age, only 17.2% of patients aged 90 years and older received home-based end-of-life care. At least 5% of all deaths occurred in individuals diagnosed with CKF. Nearly half of them also had malignancy or heart failure, suggesting that palliative care was accessible even within the current National Health Insurance system. Morphine was the most frequently used injectable opioid in the month preceding death. Among elderly patients, emergency medical care involved little attempted resuscitation. Nevertheless, home-based end-of-life care accounted for only about 20% even among the oldest old. These findings suggested the need to further promote palliative care services for CKF patients.