B JEFFREY1, T SMOLONOGOV2, L KAIRAITIS1,2
1School of Medicine, University of Western Sydney, NSW; 2Western Renal Service, Sydney, NSW
Aim: To investigate how patient characteristics and eGFR at referral to a comprehensive pre-dialysis programme influence access planning and home dialysis uptake in Western Sydney.
Background: Although pre-dialysis patient education and counselling is recommended to improve patient outcomes, optimal timing of this intervention remains unclear. Western Renal Service established a comprehensive pre-dialysis education programme in 2005 to facilitate informed dialysis modality choice and timely access planning.
Methods: Patients referred to the programme between 2005-15 prior to starting dialysis were identified. Two primary outcomes were considered: temporary haemodialysis catheter use at dialysis commencement and uptake of home dialysis. The influence of patient characteristics and eGFR at the point of referral was examined using Logistic regression analysis.
Results: 947 patients referred to the programme subsequently commenced dialysis at the time of audit; 30% with temporary haemodialysis access. Factors independently associated with temporary haemodialysis catheter use at dialysis commencement were lower eGFR at referral, presence of diabetes and patient ethnicity.
73% of patients undertook a home-based dialysis therapy in follow-up. Patient ethnicity, increased age and a diagnosis of diabetes were independently associated with a lower uptake of home-based dialysis.
Conclusions: High uptake of a home-based dialysis modality was achieved in patients referred to this programme however later referral was associated with a greater risk of starting dialysis with temporary access. Patient ethnicity and the presence of diabetes should influence the timing of referral to a pre-dialysis programme.