• Anniek D Masman, Dick Tibboel, Frans P M Baar, Monique van Dijk, Ron A A Mathot, and Teun van Gelder.
• 1 Palliative Care Centre , Laurens Cadenza, Rotterdam, the Netherlands .
• J Palliat Med. 2016 Aug 1; 19 (8): 822-9.

BackgroundPathophysiological changes at the end of life may affect pharmacokinetics of drugs. However, caregivers typically do not extensively monitor patients' laboratory parameters at the end of life.ObjectiveOur aim was to describe laboratory parameters of hospice patients in the week before death.MethodsA cohort study was conducted on available laboratory results in the week before death, including clinical chemistry and hematology tests.ResultsLaboratory data of 125 patients in a palliative care center were included, assessed at a median of 3 days before death. Eighty percent of patients had anemia and almost all had hypoalbuminemia (97%). Elevated levels of gamma-glutamyl transferase (gGT) were found in 75%, of alkaline phosphatase (ALP) in 60%, of aspartate aminotransferase (ASAT) in 60%, and of calcium (Ca) in 68%. Alanine aminotransferase (ALAT), bilirubin, sodium (Na), and potassium (K) were abnormal in from 8.8% to 36.0% of patients. A previous unknown poor kidney function was found in 60% of patients. Thirteen patients (22%) with a regular morphine prescription and one patient treated with a non-steroidal anti-inflammatory drug (NSAID) had severe kidney failure.ConclusionsAbnormal laboratory results were expected due to the pathophysiological changes that occur during the last phase of life. Remarkably, however, electrolytes (Na and K) were balanced even shortly before death. Estimated glomerular filtration rate (eGFR), reflecting the kidney function, seems the most clinically relevant laboratory parameter, because it may guide drug choice and dosing.

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