SK VENUTHURUPALLI1,2,3, A GUPTA1, A LEE1, U MAHMOOD1, S GOVINDARAJULU1,2, HG HEALY2,3,4, R FASSETT2,5,6, A CAMERON2,3,4, WE HOY2,3
1Renal Services (TBH), Darling Downs Hospital And Health Service, Toowoomba, Australia, 2NHMRC CKD.CRE and CKD.QLD, The University of Queensland, Brisbane, Australia, 3 School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia, 4Kidney Health Service (RBWH), Metro North Hospital and Health Service, Brisbane, Australia, 5School of Human Movement Studies, The University of Queensland, Brisbane, Australia, 6Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
Aim: To overview A&TSI people with CKD and their outcomes from the Darling Downs (DD) renal service. The DD is a very large area (90,000 km2), with distance a barrier to equitable health service delivery.
Background: A&TSI people have higher rates of CKD and worse outcomes than the general CKD population. More accessible and integrated healthcare delivery should improve this situation.
Methods: Included are patients with preterminal CKD enrolled in CKD.QLD in the DD renal service, age ≥18 years, who identified as A&TSI. Patients who lived ≥50 Km from Toowoomba were offered telenephrology services, and a CKD Nurse Practitioner service was established in the A&TSI community of Cherbourg.
Results: 126 patients identified as A&TSI, constituting 9.3% of patients with CKD seen in renal service. Mean age was 56.4± 12.9 years, with equal gender distribution compared with 64.6 ± 15.3 years and 55.4% males and 44.6% females in non-A&TSI patients. 46.4% were seen via tele-nephrology. Most had hypertension (93.6%), diabetes (75.2%), obesity (69.6%; BMI>30) and were current or past smokers (76.6%). Diabetic nephropathy (60%) was the leading cause of CKD, followed by GN (12.8%) and unknown (8.8%). Major comorbidities included CVD (47.2%), GORD (23.2%), depression/mental illness (23.2%), arthritis (20%) and COPD (20%). During follow-up of up to 7 years, 24 patients (19.2%) started dialysis (20 HD and 4 PD) and 20 patients died (16%) without dialysis. 5 more died after starting dialysis.
Conclusions: A&TSI people with CKD from the Darling Downs were younger, with equal gender distribution and had multiple comorbidities. High rates of modifiable health and CKD risk factors were identified. Institution of tele-nephrology and a Nurse Practitioner role improved equity of health service access.
Dr. Venuthurupalli is a consultant within Queensland Health, based at Toowoomba Hospital and a senior lecturer with Faculty of Medicine, UQ. He is completing his PhD in Chronic Kidney Disease under the mentorship of Professor Wendy Hoy, University of Queensland. He has more than 20 years experience in the field of Nephrology. He has with major publications in reputed journals. He has successfully established telenephrology as a model of care (MOC) for management of CKD patients in Darling Downs Hospital and Health Service (DDHHS) called “Reduce Miles-Spread Smiles” which was awarded Queensland Health Excellence award in December 2017.