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Kidney Week

Abstract: TH-PO276

Reasons for Referral to Kidney Supportive Care Clinic and Outcomes in Haemodialysis Population

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Jahan, Sadia, Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
  • Purtell, Louise, Queensland University of Technology, Brisbane, New South Wales, Australia
  • Bonner, Ann, Queensland University of Technology, Brisbane, New South Wales, Australia
  • Healy, Helen G., Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
  • Rawlings, Cassandra, Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
Background

In Australia, 32-40% of deaths in the dialysis population are due to treatment withdrawal. Withdrawal from dialysis is usually triggered by failure to thrive on dialysis, high symptom burden, and its associated accelerated chronic comorbid illness. The role of a dedicated multidisciplinary kidney supportive care (KSC) clinic for those on dialysis is not only in managing these symptoms but also providing support surrounding dialysis cessation where appropriate. We aim to analyse the reasons for referral of chronic haemodialysis patients to a KSC clinic and assess decision-related outcomes following the clinic.

Methods

Retrospective analysis of all persons on haemodialysis referred to KSC clinic in the 3 years from inception (February 2016). Reason(s) for referral to clinic, documented advanced care planning, number of visits, potential change of pathway and timing of death were extracted from medical records and analysed descriptively.

Results

Of the total of 364 people referred to KSC clinic, 118/364 (32%) were receiving haemodialysis. Of these, 58% were male with a median age of 69 years (range 27-89 years). Reason for referral were: control of symptom burden (65%), resolve decision-making conflict (25%), advance care planning (50%), education surrounding cessation of dialysis (30%) although some had more than one reason.

Post KSC review, 72% had documented advance care plan. Number of visits ranged from 1-12 with a median of 2 clinic reviews.

59/118 (50%) have died at the time of analysis. 38/59 (64%) opted to change pathway from receiving haemodialysis to conservative management pathway before death due to deteriorating health.

Conclusion

Access to KSC is vital in the journey of a patient with chronic kidney disease. A key role of KSC is the discussions on future planning which is usually started by the treating nephrologists and then further elaborated in KSC leading to advanced care planning. This offers tailored, patient-centred care that aligns their beliefs and preferences with their goals, aiming to not only improve quality of life, but quality of death.