XX CHIA1, R JOHNSTON1, R AGGARWAL2, T HUYNH2,3,4, S NOTARAS5,6, D ZEKANOVIC7, K GORDON1, A MAKRIS1,3,6
1Renal Department, Liverpool Health, South-Western Sydney Local Health District (SWSLHD), Liverpool, Sydney, Australia, 2Palliative Care Department, Liverpool Health (SWSLHD), Liverpool, Sydney, Australia, 3University of New South Wales, Sydney, Australia, 4Ingham Institute for Applied Medical Research, Sydney, Australia, 5Renal and Dietetics Department, SWSLHD, Liverpool, Sydney, Australia, 6Western Sydney University, Sydney, Australia, 7Social Work Department, SWSLHD, Liverpool, Sydney, Australia
Aim: Analyse the impact of Renal Supportive Care (RSC) programs on survival and hospitalisation in patients with end-stage kidney disease (ESKD) on conservative non-dialysis pathways.
Background: Conservative care is increasingly recognised as a comparable treatment pathway for older ESKD patients with multiple comorbidities. RSC programs have been developed to optimise management of these patients but evidence of their impact on patient outcomes is minimal.
Methods: A retrospective, single-centre observational cohort study of ESKD patients opting for a conservative pathway was undertaken. We assessed if management by a RSC program (RSC group), compared to usual conservative therapy (non-RSC group), impacted survival or hospitalisations. Local databases, letters and electronic medical records were used for case detection and collection of clinical data. Prevalent patients from 2015-2017 were included from when eGFR ≤15ml/min. Cox proportion hazard testing was undertaken.
Results: 177 patients were identified (96 RSC; 81 non-RSC). The median age was 82 years (IQR77.5-85.5yrs), 54% were female, the median Charlson-comorbidity Index was 5 (IQR 4-7). The RSC group had a significantly lower haemoglobin (104g/Lvs110g/L; p=0.015) and less English-speakers (36%vs56%; p=0.009). Median overall survival from eGFR≤15 was 24.5 months. After adjusting for statistical and face confounders with Cox proportional hazard testing, non-RSC was associated with worse survival HR 1.85 (95%CI 1.02–3.36; p=0.034), as was a higher comorbidity index. Non-RSC was associated with a higher number of hospital admissions per year compared to RSC (estimated means 14.5 (95%CI 9.8-19.2) vs 5.2 (95%CI 1.5-8.8); p=0.006) and higher number of days spent in hospital per year (estimated means 110days (95%CI 81-140) vs 44days (95% CI 21-67); p=0.007).
Conclusions: RSC programs are associated with improved survival and decreased hospitalisations in non-dialysis ESKD patients.
Graduated from University of Melbourne in 2011, then worked in Melbourne and Canberra before going to Liverpool Health in Sydney for Renal Advanced Training. Currently completing final year of advanced training at St George Hospital and Prince of Wales Hospital.