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S 15 Parallel session
S 15 Pre – dialysis
Saal 1, 27th September 2015,16:00 – 17:30
Programme of the session:
GS: Anne van Tellingen (The Netherlands)
Prevention strategies for the pre-dialysis patient
O 32
Characteristics of older chronic kidney disease patients in public renal practices in Queensland, Australia
Danielle Heffernan (Australia)
O 33
The nephrogeriatric clinical pathway: A new approach to pre-dialysis elderly patients in the Netherlands
Noeleen Berkhout-Byrne (The Netherlands)
O 34
Implementation of a multidisciplinary consultation for chronic kidney disease stage 4 and 5
Dierickx Katrien (Belgium)
O 35
Keeping Kidneys (KK) – a continuing journey
Danielle Heffernan (Australia)
Abstracts:
GUEST SPEAKER
Prevention strategies for the pre – dialysis patient
A. van Tellingen
O 32
Characteristics of older chronic kidney disease patients in public renal practices in Queensland, Australia
D. Heffernan1, W.E. Hoy2, A. Salisbury2, 1, J. Kirby2, A. Kark1, S. Coleman1, B. Taylor1, Z. Wang2, A. Bonner3, 1, 2, H. Healy1, 2
1Kidney Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia; 2Chronic Kidney Disease Centre of Research, University of Queensland, Brisbane, Australia; 3School of Nursing, Queensland University of Technology, Brisbane, Australia
Background: More than half the Australians who die with renal failure do not receive renal replacement therapy (RRT). Currently very little information is available about their profiles and needs.
Objectives: This study examined the characteristics of patients with chronic kidney disease (CKD).
Methods: CKD.QLD is a research and practice improvement platform for CKD in Queensland. Patients enrolled in the CKD. QLD registry (n=1018) from a large renal service were followed for up to three years.
Results: The median age was 70 years and most were male (51%). Those aged > 70 years had more advanced CKD (>=3b) 83% than those <70 years (63%). Primary renal diagnosis was more frequently renal vascular/hypertension (52% vs 19%), with fewer diabetic nephropathy (14% vs 21%) or glomerulonephritis (4% vs 16.4%). Those aged >70 years had more comorbidities than those <70 years (M= 4.9 vs 3.7) with most frequent being hypertension (82%), anaemia (71%), cardiac and vascular disease (60%), bone and joint problems (45%), dyslipidaemia (43%) and malignancies (36%). Death rates without RRT were 85 per 100 person years (vs 26 for <70 years), and rates of RRT were 13 (vs 46 for <70 years). Proportions of those admitted to hospital did not differ, but older patients had 25% greater total length of stay.
Conclusion/Application to practice: Challenges are to better understand older peoples’ health, needs and wishes. Multidisciplinary renal teams need to strengthen prospective planning and discussion of treatment options for impending renal failure. Detailed assessment of functionality, comorbidity and dependency score should be instituted as part of person-centred care approaches.
Disclosure: No conflict of interest declared
BIOGRAPHY OF THE GUEST SPEAKER
O 33
The nephrogeriatric clinical pathway: A new approach to pre-dialysis elderly patients in the Netherlands
N.C. Berkhout-Byrne1, M. Kallenberg1, 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: Older patients starting with renal replacement therapy (RRT) are at risk for cognitive and functional impairment, which leads to a high risk of mortality and loss of quality of life. Although it has been recommended, a comprehensive geriatric assessment (CGA) is not yet part of the routine work-up in this group of patients, and has not been systematically tested for its significance in quantifying functional decline as a result of initiation of RRT.
We developed a NephroGeriatric Clinical Pathway (NGCP) for older patients with CKD stage 4-5. In addition, NGCP patients are asked to participate in the COPE study (Cognitive Decline in Older Patients with End Stage renal Disease). In this presentation we share our approach to improving predialysis care for the elderly patient.
Objectives: The aim of this study is evaluate Quality of life in the context of geriatric syndromes and assess whether CGA is beneficial in aiding complex decision making in these elderly patients.
Methods: All pre-dialysis patients ≥ 65 years with CKD stage 4-5 (eGFR < 20 ml/min) are screened according to the NGCP. The test battery includes neuropsychological tests, a CGA, and consultation of a geriatrician. The CGA is performed yearly and 6 months following dialysis initiation and any major life-changing event.
Conclusion/Application to practice: The NGCP is feasible in daily practice. Future results will show the effects on cognitive and functional status after initiation of haemodialysis which can help us personalize therapeutic solutions for these patients and to build-up experience and expertise in this field.
Disclosure: No conflict of interest declared
O 34
Implementation of a multidisciplinary consultation for chronic kidney disease stage 4 and 5
K. Dierickx1, E. Hallez1, C. Debaere1, V. Resseler1, D. Kuypers1, K. Claes1
1Nephrology, University Hospitals, Leuven, Belgium
Background: Chronic kidney disease is a major health problem with a hugh impact on personal life and health care/society. Further deterioration and complications can be prevented by adhering to diet and medication treatment and by life style changes. Although, supporting selfmanagement is necessary to assist patients in acceptance of and coping with their condition. General consultation missed continuity of care and coaching of patients towards good selfmanagement.
Methods: We therefore started a multidisciplinary consultation for patients with CKD 4-5 in october 2012. Complementary to the consultation by the nephrologist, patients were followed by an advanced nurse practitionar, a dietician and social worker on a regular basis. After one year we did an evaluation in the team and patient population.
Results: Since october 2012, 287 patients were followed on this consultation, of which 75 started dialysis yet. The consultation enabled us to use effective interventions (personal and holistic approach, counseling, motivational interview techniques, social support, …) in promoting selfmanagement in chronic patients. Blood results are known on the moment of consultation which made it possible to give patients immediate feedback on their renal function and adherence with therapy. It also motivates them to compliance and life style changes. Conclusion/Application to practice: Both health professionals and patients were very satisfied with the new consultation concept. Although we weren’t yet in the occasion to study outcomes, experiences of both team members and patients are promising for good outcomes. Further research is needed to evaluate this practice improving consultation concept.
Disclosure: No conflict of interest declared
O 35
Keeping Kidneys (KK) – a continuing journey
D. Heffernan1, M. Terry1, C. Bowering2, S. Ersham3, C. Van Eps3, S. Williams2, T. Johnson2, A. Bonner4, 1, H. Healy1
1Kidney Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia; 2Inala Primary Care, Brisbane, Australia; 3Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia; 4School of Nursing, Queensland University of Technology, Brisbane, Australia
Background: Chronic Kidney Disease (CKD) is an increasing burden on healthcare systems. The Keeping Kidneys (KK) model of care emerged to address the large gap between predictive demand and service delivery. KK involves General Practitioners (GP), Practice Nurses (PN) and specialist renal teams collaborating to manage patients with CKD in the primary healthcare settings.
Objectives: KK aims to preserve kidney function and slow the progression of CKD through the transfer of core kidney specialist skills to GP and PN thereby reducing the burden on public hospitals.
Methods: Core skills from specialist renal teams were transferred to GPs and PNs through a combination of education sessions, shadowing and inclusion in patient education sessions. Participant’s skills were assessed with pre/post Learning Review Summaries. The demographics of patients referred to the KK clinics and time to kidney diagnosis were recorded.
Results: 79 patients were referred in the first six months. 100% of patients have received education from the PNs and assessment from GPs. 26 patients have been discharged back to the referring GP with a Health Management Plan, four have been referred to the participating renal service and 49 remain within the KK clinic.
Conclusion/Application to practice: The KK clinic is established and supports ongoing collaboration between GPs, PNs and specialist renal teams. The clinic has released capacity within the participating renal service to manage emergent demand for acute care. The pilot business case demonstrates a return on investment of $5,000 for every $1,000 spent and estimates of an established service are estimated at 12:1.
Disclosure: No conflict of interest declared