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S 22 Parallel session
S 22 CKD Risk factors & Prevention
Saal 2, 28th September 2015, 11:00 - 12:30
Programme of the Session:
GS:
Congenital anomalies of Kidney and Urinary Tract (CAKUT): from prenatal diagnosis to CKD in adulthood "
O 54
An integrated nurse practitioner-led service for people with chronic kidney disease
Ann Bonner (Australia)
O 55
Risk factors of CKD in the World Kidney Day: 2500 tests in general population
David Hermán Gascue (Spain)
O 56
Regret with the decision to start dialysis in older patients: a Dutch survey
Noeleen Berkhout-Byrne (The Netherlands)
O 57
Risk factors for chronic kidney disease: World Kidney Day survey 2010 – 2015 compared
Sarah Crols (Belgium)
Abstracts:
O 54
An integrated nurse practitioner-led service for people with chronic kidney disease
A. Bonner1, C. Stone2, M. Barnes2, J. Abel2, C. Douglas1, K. Havas1, N. Ghafouryn Gomish Bachi1
1School of Nursing, Queensland University of Technology, Brisbane, Australia; 2Logan Hospital, Logan, Australia
Background: Chronic disease healthcare is typically a medical specialist led extension of acute management often in hospital outpatient clinics. There are often long waiting times for a clinic appointment, leading to late stage presentation, worsening of symptoms, increasing complications, and fragmentation of healthcare particularly for those with multiple chronic diseases. In Australia there are several nurse practitioner (NP) CKD clinics for patients with CKD (stages 2-5). NPs hold a Masters level of qualification and authorized to practice autonomously, order and interpret diagnosis investigations, make referrals to other clinicians, and prescribe medications. NP clinics are, however, also structured duiring isease siloes like medical practitioners’ clinics which is problematic for people with CKD who typically have multiple comorbidities.
Objectives: To describe an innovative nurse practitioner-led model of care that is person-centered and reflects the multi-morbidity of people with chronic kidney disease (CKD) who require healthcare.
Conclusion/Application to practice: A novel, structured, community-based integrated NP clinic for patients with at least two chronic diseases (CKD, diabetes or heart failure) commenced in June, 2014. The clinic, staffed only by NPs, improves access, efficiency, and quality of service through a coordinated design. Patients are referred for medical consultation only when required. The focus is on supporting patient adherence with complex chronic disease self-management. Patient presentations to hospital with disease exacerbation have been reduced, clinical targets are achieved, and patient satisfaction is high. Challenges include funding and improving processes. The integrated chronic disease NP-led service has the ability to be replicated internationally.
Disclosure: No conflict of interest declared
O 55
Risk factors of CKD in the World Kidney Day: 2500 tests in general population
D. Hernán Gascueña1, A. Hernández Pérez1, J. Cabrejos1, R. Díaz Manjón1, C. Pereira Feijoo1, M. Luz Sánchez Tocino1, A. Rossignoli1, J. Berea Ruiz1, J. Luis Santos1, V. Turrión Cabezas1
1Nursing, Fundación Renal Íñigo Álvarez De Toledo, Madrid, Spain
Background: The Kidney Foundation Iñigo Álvarez de Toledo, wanted to join the initiatives of the World Kidney day, organizing some tents in the street at eight cities of Spain to perform simple tests to any citizen. Nurses have done controls of blood sugar, blood pressure and blood capillary creatinine (to measure renal function MDRD-estimated).
Objectives: To raize awareness to the general population about kidney disease risk. To publicize the WKD by health education and health promotion
Methods: Prospective study with volunteers who wanted to participate in public places (a sample of 2500) on the second Thursday of March from 2009 to 2014. We have collected the following parameters: age, weight, height, sex, race, value of capillary creatinine (with REFLOTRON Roche), value of capillary blood glucose (Accucheck-Aviva Roche), values of blood pressure (Omron digital blood pressure).
Results: We have found a very high percentage of people with MDRD lower than 60 (11.9%), probably because the average of age was also high (58,6 years). This numbers are higher than some others studies over the population.
The BMI was higher of 25 for the 63.77% of the sample. And the 20.85% of the people tested had more than 140/85 of blood pressure. Conclusion/Application to practice: It is very important to know the risk of CKD for the population in order to prevent the sickness. We have identified a lot of people at first stages of renal failure. So, these people can take care of themselves to delay or to stop the initiation of a dialysis program.
Disclosure: No conflict of interest declared
O 56
Regret with the decision to start dialysis in older patients: a Dutch survey
N. Berkhout-Byrne1, T.J. Rabelink1, S.P. Mooijaart2, A. Gaasbeek1, M. van Buren1
1Nephrology, Leiden University Medical Center, Leiden, Netherlands; 2gerontology and geriatrics, Leiden University Medical Center, Leiden, Netherlands
Background: More older patients with end stage renal disease are starting with dialysis. Elderly patients often prefer a treatment that focuses on quality of life rather than primarily on extending life. In a Canadian study 61% of 584 dialysis patients (mean age 68 years) regretted their decision to start dialysis. It is unknown if Dutch dialysis patients, particularly older patients, regret their decision to initiate dialysis.
Objectives: Our primary objective was to measure the percentage of patients in the Netherlands who regret their decision to start
dialysis.
Methods: A short questionnaire was developed and included questions about age, satisfaction with pre-dialysis education and present treatment, dialysis initiation, regret decision to start dialysis and key figures in the decision making process.
Results: 28 units (42%) finally participated in the survey. 2624 questionnaires were issued and 1371 were returned for the final analysis (52% response). 7.2% of patients regretted their decision to start dialysis, 92.7% reported being satisfied with the treatment. 50.5% reported the nephrologist `s opinion to be crucial in the decision making process. 52.8% of participants described dialysis initiation as being acute, older age associated with less regret (r = 0.076; P = 0.006).
Conclusion/Application to practice: The majority of patients did not regret their decision to start dialysis. Older patients are more satisfied with their treatment and feel less regret. The nephrologist `s opinion seems to be paramount in the decision making process and is associated with regret. Further research is necessary to clarify the role of healthcare providers in the decision making process.
Disclosure: No conflict of interest declared
O 57
Risk factors for chronic kidney disease: World Kidney Day survey 2010 – 2015 compared
N. Van Paesschen1, M. Roden1, P. Vanderniepen1, P. Janssens1, C. Tielemans1, Nursing Staff Hemodialyse UZ Brussel, S. Crols1
1Nephrology Department, UZ Brussel, Brussels, Belgium
Background: The aim of World Kidney Day (WKD) is to highlight the importance of kidney function for morbidity and mortality and to reduce the impact of chronic kidney disease (CKD) on global health. The epidemiology of CKD and associated risk factors is rapidly changing and a significant proportion of the population is unaware.
Methods: On WKD 2010 we organized an anonymous screening in accidental passer-by’s in the lobby of our hospital. People were invited to have arterial blood pressure measurement (BP) and blood glucose determination under standardized conditions. We also gathered information on personal and family history. On WKD 2015 we will repeat and expand our survey and compare the results.
Results: In 2010 we screened 325 subjects. 56% were women. Overweight was significantly more prevalent in men. 54% had hypertension. Women had significant lower systolic BP. 6.5% reported DM. Blood glucose suggested diabetes mellitus in two persons previously unaware. Mean BMI was 25.5 kg/m2, in line with mean BMI of 25.3 kg/m2 in Belgium in 2008. Remarkably, 22% reported no overweight while their BMI was markedly elevated.
Conclusion/Application to practice: Screening in 2010 revealed that risk factors for CKD such as hypertension, increased BMI, diabetes and smoking were highly prevalent. A significant proportion was previously unaware of this. We will repeat our survey to identify more persons at risk. We will also compare the 2 surveys to gather data on the evolving epidemiology and to promote livestyle changes to citizens and authorities.
Disclosure: No conflict of interest declared