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Abstract: PO2401

Impact and Outcomes of Advance Care Planning in CKD

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Tan, Shanti, Tan Tock Seng Hospital, Singapore, Singapore
  • Koh, Timothy Jee Kam, Tan Tock Seng Hospital, Singapore, Singapore
  • Pang, Eileen, Tan Tock Seng Hospital, Singapore, Singapore
  • Looi, Wan Limm, Tan Tock Seng Hospital, Singapore, Singapore
  • Yeo, See Cheng, Tan Tock Seng Hospital, Singapore, Singapore
Background

The incidence of chronic kidney disease (CKD) is rising, with patients being older and having more chronic disease at time of dialysis initiation. Advance care planning (ACP) has been advocated to better align treatment with patient preferences, facilitate shared decision making and improve patient-centred care. We aim to evaluate the impact of ACP on patient-centred outcomes and describe patient preferences expressed during ACP.

Methods

We conducted a retrospective cohort study of patients who underwent ACP from January 2013 to March 2021, comparing outcomes with age-, gender-, aetiology- & renal replacement therapy (RRT) decision-matched patients without ACP. Outcome measures include intensive care unit (ICU) admissions, number of hospitalisations per year, change in decision for renal palliative care (RPC) and referral to palliative physician.

Results

198 patients underwent ACP during the study period, with a median age of 77 years old. 52.5% of patients in the ACP cohort were referred as they chose RPC. Other reasons for ACP included patients with difficulty tolerating dialysis, vascular access issues, long-term catheter-based dialysis and significant comorbidities. Majority of patients who underwent ACP elected not for cardio-pulmonary resuscitation (80.8%) or admission to ICU (77.8%), 9.6% of the cohort changed their mind about subsequent treatment plan.

Compared to 197 patients in the matched-control group, patients with ACP were less likely to be admitted to ICU (5.0% vs 14.7%, p=0.001). In patients who chose RPC, those with ACP were less likely to have a change in decision for conservative management of CKD (8.6% vs 20.2%, p=0.018), had fewer hospital admissions a year (1.21 vs 1.92, p=0.001) and were less likely to require palliative referral (44.2% vs 61.5%, p=0.013).

Conclusion

ACP should be considered in CKD patients to help align goals of care and treatment preferences. When considering patients who chose RPC, patients who undergo ACP are more likely to be consistent with their plan for conservative management of CKD, including a reduced utilization of resources like ICU care, palliative care involvement and hospital admissions. This ensures appropriate diversion of resources and allows alignment to patient’s treatment preferences.