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Kidney Week

Abstract: TH-PO343

Comprehensive Approach to Renal Education and Support: Methods and Outcomes

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Khan, Sana F., UVA Health, Charlottesville, Virginia, United States
  • Wentworth, Danielle, UVA Health, Charlottesville, Virginia, United States

Group or Team Name

  • UVA CARES - Comprehensive Approach to Renal Education and Support.
Introduction

The 2019 Advancing American Kidney Health Initiative aims to increase home dialysis utilization and improve access to kidney transplantation. In our approach to achieve these goals, we designed a quality initiative to provide comprehensive, patient-centered nephrology care for patients with high risk of disease progression.

Case Description

This QI project started January 2021. High risk patients were identified via EMR registry. Inclusion criteria was GFR < 30 ml/min or KFRE score > 20% at 2 years. Patients were contacted and offered enhanced education and support regarding modality choices & CKD progression.
Patients were sequentially scheduled with an experienced nephrology NP, Social Worker, dietician and home dialysis nurse, with an
additional NP follow up visit to determine further education, resource needs, ESRD decision plan and tracking.
Patient modality choices were subsequently relayed to primary nephrologists and documented in the EMR. Patient progress and gaps in coordination were discussed during quarterly list management meetings.

Discussion

Our cohort included 42 patients (Average age; 65 years, GFR 16 ml/min, KFRE 53%).35% patients completed all 5 comprehensive visits.78% made decisions on preferred modality (33% iHD, 40% PD, 21% undecided). 20 patients (47%) progressed to ESRD, with incident rates of PD 25% and iHD 75%. 7% patients died prior to ESRD progression. 9 patients (45% of ESRD group) initiated hemodialysis as in-hospital starts.
36% (n=8) of patients without progression to ESRD are with AVF/AVG placement, awaiting RRT initiation.
Transplant status include 2 patients on the active, 10 inactive transplant lists. 23 referrals were closed due to patient ineligibility whereas 1 patient received a pre-emptive transplant.

Development of a multidisciplinary high-risk nephrology care clinic at our institution resulted in attainment of improved rates of incident PD utilization, which surpassed rnational benchmarks. Significant number of our patietns without ESRD progression are expected to have optimal start RRT with functioning AV access. Despite advanced care planning, 45% of our ESRD starts initiated RRT in hospital, demonstrating high complexity of care/disease burdent of advanced CKD patients. Adoption of comprehensive care models for patients at increased risk for development of ESRD may lead to improved patient outcomes while also meeting national quality metrics.