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Kidney Week

Abstract: PO0581

Patient Outcomes Following Discharge from a CKD Clinic

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Che, Michael, Queen's University Department of Medicine, Kingston, Ontario, Canada
  • Thanabalasingam, Susan Jeevana, Queen's University Department of Medicine, Kingston, Ontario, Canada
  • Iliescu, Eduard A., Queen's University Department of Medicine, Kingston, Ontario, Canada
  • White, Christine A., Queen's University Department of Medicine, Kingston, Ontario, Canada
Background

In Ontario, Canada multidisciplinary care for patients with advanced chronic kidney disease (CKD) is delivered in Multi-Care-Kidney-Clinic (MCKC) operated by Regional Programs funded through a provincial network based on the number of eligible patients. These eligibility criteria were progressively revised between 2016 and 2018 from an absolute estimated glomerular filtration rate (eGFR) less than 30 ml/min/1.73m2 to less than 15 ml/min/1.73m2 or a two-year risk of end-stage kidney disease, calculated by the Kidney Failure Risk Equation (KFRE), greater than 10%. The objective of this study was to ascertain the outcomes of existing MCKC patients who were discharged as these criteria were implemented.

Methods

This is a retrospective cohort study of prevalent CKD patients in MCKC in 2013 in the region of South Eastern Ontario, followed to January 2020.The outcomes were discharge from MCKC, re-referral, initiation of kidney replacement therapy (KRT), and death. Data were extracted from electronic medical record. Death was ascertained through Ontario’s Office of the Registrar General. Patients’ 2 and 5-year KFRE scores were calculated using the 4-variable KFRE.

Results

Of the 643 MCKC patients in 2013 with available data, 470 (73%) continued follow-up in MCKC, while 142 (22%) and 31 (5%) were discharged to primary care and general nephrology respectively. Of those discharged to primary care, 52 (37%) died, while 15 (11%) were re-referred to nephrology, and 8 (6%) initiated KRT within median (IQR) times of 982 (560) and 850 (1411) days from discharge respectively. Five (63%) of the 8 discharged patients who required KRT did so for unforeseen acute illness rather than progressive CKD.

Conclusion

The results of this study suggest that gradually moving MCKC funding eligibility criteria from absolute eGFR level to one based on both eGFR and the KFRE prediction model resulted in the discharge of a significant number of patients. Notably, few of the discharged patients ultimately required KRT that could have been prevented. This study offers a regional perspective with low loss to follow-up as there is only one Renal Program in the region. The results may not be generalizable to different populations, health care systems, or predictive models. Further research is needed to establish the optimal KFRE criterion upon which MCKC funding eligibility can be based.