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Kidney Week

Abstract: TH-PO644

Early Outcomes from an Ambulatory Kidney Palliative Care Program

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Scherer, Jennifer S., New York University Langone School of Medicine, New York, New York, United States
  • Moriyama, Derek Susumu, New York University Langone School of Medicine, New York, New York, United States
  • Agoha, Chikadibia, CUNY School of Medicine, Suffern, New York, United States
  • Brody, Abraham, New York University, New York, New York, United States
  • Modersitzki, Frank, New York University School of Medicine, New York, New York, United States
  • Chodosh, Joshua, New York University Langone School of Medicine, New York, New York, United States
Background

Patients with advanced kidney disease have an elevated symptom burden, increased mortality, and poor quality of life. While palliative care can address these issues, nephrology patients infrequently receive such care. To address this, we implemented an ambulatory kidney palliative care program. We describe our initial outcomes.

Methods

Utilizing chart abstractions, we characterized the clinic population and symptom burden for patients seen from May 6, 2016-July 6, 2018.

Results

Ninety-four patients were referred; 74 (78.7%) patients seen. Forty (54.1%) had follow-up appointments (range 2-13). Mean patient age was 72.7 ±16 years with 32 (43.2%) on dialysis. The mean symptom burden (n=65) was 12 (± 4.9) symptoms (out of 17) with mean severity of 2 (range 0-4), representing moderate severity. The most common physical symptoms were nausea (78%), dyspnea (72%), pain (68%) and itch (66%). Eighty-seven percent reported anxiety and 73% reported depression. There was no difference in symptom burden between patients on dialysis and those on conservative management (n=22). Patients on conservative management were significantly older and had more comorbidities. By visit two, there was a significant reduction in global symptom score (21.9 vs 19.0, p=0.01) in addition to a reduction in anxiety (2.1 vs 1.7, p=0.03), vomiting (0.8 vs 0.2, p=0.04), and restless legs syndrome (1.3 vs 0.8, p = 0.02).

Conclusion

Patients with serious kidney disease treated in a kidney palliative care clinic have a high symptom burden regardless of treatment choice. The decision to pursue conservative management is more prevalent in older patients with more comorbidities. Follow up visits to the clinic demonstrated a decrease in symptom burden, suggesting that a dedicated kidney-palliative care clinic may be successful in managing symptoms and addressing unmet need.

Funding

  • Other NIH Support