A SIRIWARDANA1, A HOFFMAN1, F BRENNAN1, K LI1, M BROWN1,2
1Department of Renal Medicine, St George Hospital, Kogarah, Australia, 2University of New South Wales, Kensington, Australia
Background: Renal supportive care (RSC) is a recognised management approach for end-stage kidney disease (ESKD) patients on a non-dialysis pathway to improve symptom control, quality of life and advanced care planning. However, patients on dialysis also carry a heavy symptom burden, and little is known about the role of RSC intervention in this population.
Aims: To assess if there is an improvement in symptom burden in patients on dialysis after intervention by a RSC team.
Methods: In this prospective observational study, symptoms were measured using the POS-S Renal and iPOS-Renal tools in 61 hospital haemodialysis, 5 home haemodialysis and 16 peritoneal dialysis patients who attended a RSC clinic for symptom control between April 2010 and December 2017. Symptoms were assessed on initial attendance and at subsequent clinic visits.
Results: The mean age was 71 years (SD 12), 63% male, with an average of 3 (SD 1.5) co-morbidities and Charlson score 7 (SD 2). 61% had diabetes and 38% cardiovascular disease. Mean follow-up between 1st and 3rd visit was 5.5 months. Mean total symptom score at baseline was 18 (SD 10), the most overwhelming/severe symptoms being pain (30%), lack of energy (28%), difficulty sleeping (30%), poor mobility (17%) and itch (20%). There was significant improvement in total symptom burden over 3 clinic visits (18.2 vs 14.7, p=0.015) and after 12 months follow-up (13.8, p=0.047). There was significant improvement in scores for all 5 of the most severe symptoms (p<0.001).
Conclusions: Use of a RSC team that focusses on symptom control and holistic patient-centred care is associated with improved total and individual symptom burden in dialysis patients who are suffering from high symptom burden despite adequate dialysis.
Amanda Siriwardana is a 3rd year Advanced Trainee in Sydney who has trained in the East Coast Renal Network and is currently the Transplant Fellow at Royal Prince Alfred Hospital. She has an interest in CKD, dialysis and renal supportive care, with a particular focus on patient-centred care and improving quality of life in renal patients across all management pathways.