Aim & Background: 
Renal patients, particularly those on dialysis, are known to have high morbidity and mortality risks, and their illness trajectory often leads to death in hospital. We aimed to identify the intensity of interventions and treatment renal patients experience during their final hospital admission.

Methods: 
Utilising electronic medical records and Rapid Response Team (RRT) data, we performed an audit of the terminal admissions of adult renal inpatients who died in a large tertiary hospital between January 2020 to September 2021 and their final 6 months of life. We collected demographic data and treatment information regarding their final 6 months as well as escalations of care during the terminal hospital admission prior to death, including time in intensive care, RRT data and number of invasive interventions such as surgery.

Results: 
We identified 90 patients who died in hospital during the specified period; 19% were from regional or rural areas. The majority were on haemodialysis (51/90, 56.7%) and had over 3 comorbidities (56.7%). Of those not on dialysis at presentation, 32% (8/25) were initiated on dialysis. During the final admission, 52.2% (47/90) had a RRT call, 38.9% (35/90) an intensive care stay, and 54.4% (49/90) underwent an invasive intervention. In the preceding 6 months, 44.4% (40/90) had had 2 or more hospital admissions and 23.3% (21/90) presented to the emergency department 4 or more times. Only 10% had completed an advanced care directive prior to the final admission.

Conclusion: 
Our audit highlights the treatment burdens renal patients can experience towards the end of life, and possible missed opportunities for identifying a patient’s values and achieving goal-concordant care. Being able to identify patients with terminal trajectories may facilitate advanced care planning, earlier involvement with palliative care, and help to reduce recurrent hospital presentations and unnecessary interventions.