“A CHANGE OF HEART”: A CASE SERIES ANALYSIS OF END STAGE KIDNEY DISEASE PATIENTS CHANGING FROM CONSERVATIVE TO ACTIVE DIALYSIS TREATMENT.

K NGUYEN1, S SINHA1, B HENDERSON1, S WONG1, S ROXBURGH1

1Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW.

Background: Older patients have a higher burden of morbidity/mortality when treated with dialysis for end stage kidney disease (ESKD), particularly if they have multiple comorbidities. An increasing number of ESKD patients thus elect for a renal supportive care (RSC) pathway. A percentage of these then undergo a “change of heart” (COH). There is limited data in the literature about outcomes in this group.

Methods: We conducted a single centre retrospective review of our CKD nurse educator database, identifying those who elected RSC but then changed to a dialytic pathway. We cross referenced against hospital medical records and our general renal unit database. We evaluated baseline demographics, the reasons behind the changed decision, and subsequent morbidity/ mortality.

Results: Between 2012 and 2017, 8 patients have undergone a COH at our institution. Mean age; 72.9 years, mean number of comorbidities; 6 per patient. Male; female ratio; 3;1.6 of 8 had undergone CKD education, and clearly elected RSC. 5 had a COH during hospital admission for acute on chronic renal decline. 5 were still living, with 3 deceased by study end. Average length of hospitalisation; 44.9 days after COH, with an average of 5.1 emergency presentations/ hospitalisations per patient.

Conclusion: Many of the patients in this case series underwent a COH during a period of acute illness, when faced with life-threatening decompensation. Despite COH, they faced long and multiple hospitalisations. Recommendations for improvement include clearer inter-institutional communication and coordination, early engagement of specialist palliative care services, and regular discussions with the patient and key family members.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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