Kidney Week

Abstract: SA-PO851

The Keeping Kidneys Program: Baseline Results from a New Model of Care for Community Kidney Health

Session Information

• CKD: Socioeconomic Context and Mobile Apps
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gois, Pedro Henrique Franca, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Pedro Henrique Franca Gois,

• Purtell, Louise, Queensland University of Technology, Brisbane, New South Wales, Australia

Louise Purtell,

• Bonner, Ann, Queensland University of Technology, Brisbane, New South Wales, Australia

Ann Bonner,

• Chang, Gary KF, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Gary KF Chang,

• Lal, Vinod, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Vinod Lal,

• Cation, Alexandra, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Alexandra Cation,

• Kark, Adrian Lawrence, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Adrian Lawrence Kark,

• Healy, Helen G., Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Helen G. Healy,

Background

Intervention in early-stage CKD slows rate of progression. First contact healthcare providers like general practitioners (GPs) are at the forefront of detection and management of the early stages of CKD. Keeping Kidneys (KK) was implemented in 2018 to augment kidney care skills of GPs in a less-privileged socio-economic area of Queensland, Australia, where access to specialized kidney care was not available. Here we describe the characteristics of patients referred to this program.

Methods

Two GPs were recruited and trained in a specific subset of CKD skills. Training included didactic knowledge acquisition and clinical detailing by a nephrologist. Demographic and clinical data were extracted from electronic medical records; patient-reported outcomes (CKD knowledge and self-management) were completed at KK entry. Data were analysed descriptively (frequency distributions and mean/median as appropriate).

Results

140 patients were referred to KK in the first 8 months. Median age was 76 years (67-81). Most patients were in CKD stage 3B (54%) or 3A (22%). Hypertension and diabetes were the leading CKD causes but 33% had no aetiological diagnosis at entry. Most patients had low-average scores for CKD knowledge (13±14/28) and CKD self-management (46±6/116). Median Charlson comorbidity score was 7, predicting survival of <10 years. Mean haemoglobin (Hb) was 12.6±2 g/dL and 5% of patients had Hb<10g/dL. Mean parathyroid hormone, calcium (Ca⁺⁺) and phosphate (PO⁴) were respectively 94±81 pg/mL, 9.6±0.5 and 3.4±0.5 mg/dL. Prevalence of hypoCa⁺⁺ and hyperPO₄ were respectively 1% and 2%. Median urine albumin:creatinine ratio was 38 (12-75) mg/g. One patient was referred for renal biopsy and one for bone marrow biopsy. Patients travelled, on average, 25 minutes less for their appointments, with 72% seen within 15 km of their homes.

Conclusion

KK focuses on the interface between patients, GPs and specialists. Trained GPs were capable of staging severity of kidney disease, initiating the work up of the cause/s of the kidney disease and screening for complications. They managed a cohort of patients with CKD that were elderly, had intermediately advanced CKD and complex co-morbidities in their communities.

Funding

• Other U.S. Government Support