L PURTELL1,2,3, A BONNER1,2,3, HG HEALY2,3,4
1Faculty of Health, Queensland University Of Technology, Brisbane, Australia, 2Kidney Health Service, Metro North Hospital & Health Service, Brisbane, Australia, 3Chronic Kidney Disease Centre of Research Excellence, Brisbane, Australia, 4Kidney Research Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
Aim: To describe the characteristics of younger people with end-stage kidney disease (ESKD) requiring kidney supportive care (KSC).
Background: Advanced age is a predictor of poor outcomes for people with ESKD; consequently, supportive care pathways tend to be geared towards older people considering withdrawal from kidney replacement therapy (KRT) or being managed conservatively. However, a discrete group of younger people with ESKD also need support around decision-making conflicts, symptom distress and psychosocial problems. We describe the characteristics of a young cohort of people with ESKD who were referred to a multidisciplinary KSC program from 2016–2018.
Methods: We extracted data from clinical records and compared gender, indigenous status, treatment modality and reason for referral to KSC between those ≤50 years of age at time of referral and those >50 using chi square tests (p<0.05 considered statistically significant).
Results: Of 260 people referred to KSC, the median age was 73.5 years; however, 12% were ≤50 (range 27–50). Gender splits were similar with 43% female ≤50 and 47% >50 (p=n.s.). Aboriginal and Torres Strait Islander (A&TSI) people were overrepresented in ≤50 (20% vs. 3% >50; p<0.0001). Those ≤50 were more likely to be receiving (or on a transition pathway to) KRT at referral than those >50 (100% vs. 48%, respectively; p<0.0001), and more likely to have been referred for symptom management (73% vs. 42%, respectively; p=001).
Conclusions: Although most people referred for KSC are elderly, younger people with ESKD are also accessing KSC for the management of symptoms while receiving KRT; this is disproportionately frequent in A&TSI people. Symptom relief in ESKD is emerging as a gap in care that requires a specialised skill set.
Dr Louise Purtell is a postgraduate research fellow in the Faculty of Health, Queensland University of Technology and a member of the Chronic Kidney Disease Centre of Research Excellence.