L MYAT1, D CHRISTIADI1,2, C STEVENS1, M KELLEHER1, S CHIMOMBE1, D KNAGGE1, A KANG1,2, Z ENDRE1,2, M SANDS1,2, K YONG1,2
1Prince of Wales Hospital, Ranwick, Australia, 2Prince of Wales Hospital Clinical School, University of New South Wales, Randwick, Australia
Aim: To describe the first five-year progress of RSC services at a Sydney metropolitan hospital.
Background: Renal supportive care (RSC) is an interdisciplinary model of care focused upon quality of life, symptom control and end-of-life care for advanced chronic kidney disease (CKD) patients.
Methods: We performed a retrospective analysis of the POWH RSC cohort from October 2015 to July 2020. Independent t-test and chi-square were used to compare continuous and categorical variables respectively between RSC patients and non-RSC dialysis patients. Survival was analysed using Kaplan-Meier approach.
Results: Prince of Wales Hospital (POWH) RSC is based upon the St. George Hospital (SGH) model. RSC referrals increased by 150% over the study period; five (2015), twenty-one (2016), twenty (2017), thirty-seven (2018), forty (2019) and forty (2020). RSC referrals exceeded new dialysis starts in 2018 (thirty-three), 2019 (twenty-nine) and 2020 (twenty-six). 84 of the 163 RSC patients (52%) died throughout the study with median survival of 12 months (95%CI 8-25months) from time of referral. 58% of RSC deaths occurred at home or hospice.
RSC patients were older (79.7±9.5 vs 69±8.7years; p=0.01), had increased dementia (19% vs 4%; p=0.02) but similar levels of other medical comorbidities compared to non-RSC dialysis patients. Regular 6-monthly IPOS surveys in all non-RSC dialysis patients demonstrated significant symptom burden with regards to pruritus (40%), insomnia (48%), depression (49%) and fatigue (58%). This information was used to encourage referral of dialysis patients to RSC. The proportion of dialysis patients within the RSC cohort increased over time from 15% (2015-2017) to 35% (2018-2020).
Conclusion: A dedicated RSC team and integration of regular IPOS surveys as standard-of-care are important for establishment and success of RSC at POWH.
Nephrology Advanced Trainee