Abstract: TH-PO555

Nephrology Practices and Patient Perspectives in regards to Conservative Care for ESKD: The Chronic Kidney Disease-Renal Epidemiology and Information Network Study (CKD-REIN)

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Speyer, Elodie, INSERM-CESP, UPSud, UVSQ, Villejuif, France
  • Stengel, Benedicte, INSERM-CESP, UPSud, UVSQ, Villejuif, France
  • Frimat, Luc, CHU de Nancy, Vandoeuvre les Nancy, France
  • Ayav, Carole, CHU de Nancy, Vandoeuvre les Nancy, France
  • Combe, Christian, CHU de Bordeaux, Bordeaux, France
  • Fouque, Denis, Université Claude Bernard, Pierre Benite, France
  • Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France
  • Laville, Maurice, Université de Lyon, Pierre-Bénite, France
  • Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Group or Team Name

  • CKD-REIN Investigators
Background

Current KDIGO guidelines indicate that patients with advanced CKD should receive information on all renal replacement therapy (RRT) options, including conservative care (CC), but little is known about nephrologist practices and patient perspectives in regards to CC.

Methods

CKD-REIN is a prospective cohort study that enrolled 3,033 adult patient with CKD stage 3-5 (45% in stage 4-5) from a national representative sample of 40 nephrology clinics in France. Nephrologists were surveyed about practices regarding information, whether they offer, and clinic organization about CC. Patients completed a self-administered questionnaire (PQ) including their understanding of, education on, and preferences for RRT options, including CC.

Results

Among 31 clinics with data, 33% had a guideline (implemented or in preparation) for managing ESRD by CC. Eighty-two percent of the 131 respondent-nephrologists (mean age=44±10; 53% men) reported to be fairly or extremely comfortable with discussing CC with patients, but only 29% reported discussing it with all patients aged 75+. Patient’s quality of life and preference for CC were more likely to influence nephrologists when contemplating the suitability of CC than medical or social conditions (figure 1). Among the 1,363 patients with CKD stage 4-5 (88% PQ respondents; 70% men; 35% aged ≥75), 5% of 75+ year-old patients reported to have been informed by their doctor about the "no treatment" option; and 2.3% stated they would choose the "no treatment" option if their kidneys failed.

Conclusion

Despite guidelines and that nephrologists declare that patients with advanced CKD receive information about all RRT options, patients report limited knowledge about CC, especially in elderly. In-depth studies about discrepancies between current practices and the CKD patient perception as they approach kidney failure are requested.

Funding

  • Commercial Support