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Abstract: FR-PO515

The Transition Care Programme: Our Experience in the Last 10 Years

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Jahan, Sadia, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Summers, Kara, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Giugni, Rachel, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Nicholas, Pauline A., Metro North Hospital and Health Service, Brisbane, Queensland, Australia
  • Ranganathan, Dwarakanathan, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
Background

Home therapies including peritoneal dialysis (PD) & home haemodialysis (HHD) are associated with better outcomes in patients with end stage kidney disease (ESKD) as compared to in-centre dialysis. Home therapies allow patients autonomy and flexibility with proven improved quality of life. Treating end-stage kidney disease at home means less travel & its associated cost. The cost of HHD to the health care system is the lowest of all dialysis modalities while incentre dialysis is the most expensive.

‘Home, Independent dialysis and Transition Service’ (HITS) was commenced in July 2009 within the Kidney Health Service. Since its inception, the uptake of home therapies has increased over the 10 years.

Methods

A retrospective analysis of patients referred to HITS and incident patients requiring kidney replacement therapy (KRT) between Jan 2009 and Dec 2018 with 6 months follow-up after their chosen modality. Incident home therapies pre- HITS and all prevalent dialysis patients via HITS were also analysed.

Results

Incident Home therapies increased from 44% in 2006 (pre-HITS) to 69% in 2018. There was an increased uptake of PD by 13.5% with 25 patients choosing PD in 2006 and 45 patients in 2018. The uptake of HHD remained at 20%.

From the prevalent dialysis pool there was an increase in patients choosing HHD from transplant, incentre dialysis and PD from 28.6% in 2013 to 50% in 2018.

Patient were followed up for 6 months and due to reasons including PD peritonitis, technique failure, haemodynamic instability rendering HHD unsafe, between 5-15% patients transitioned from home therapies to incentre haemodialysis.

Conclusion

Home therapies was relocated to the suburbs and away from the main hospital campus in 2006. The Transition unit followed in 2015. Since this initiative, the uptake of home therapies has increased which is largely due to the increased availability of pre-dialysis and specific home therapies nurses, medical support and a dedicated multi-disciplinary team.

However, KRT modality in home therapies at 6-months are still not being maintained which necessitates stringent patient selection criteria with rigorous and intense education.

Our transition unit has seen the increase in the uptake of home therapies however more work is required to keep patients on these modalities.