J MAH1, M DAMASIEWICZ1,2, P BRANLEY1, G REID1, P KERR1,2, K LINTON2
1Department of Nephrology, Monash Health, Monash Medical Centre Clayton, Clayton, Australia, 2Department of Medicine, Monash University, Clayton, Australia
Aim:To highlight the demographics and symptom burden of Stage 4/5 end stage kidney disease (ESKD) patients choosing to forgo renal replacement therapy attending a new supportive care clinic (SCC) in a large tertiary centre.
Background:Patients with Stage 4/5 ESKD experience significant physical and psychological symptom burden that remains under-recognised in clinical practice. The Palliative Care Outcome Scale (POS-S) Renal is a patient reported outcome measure developed to evaluate symptom burden, and consists of 17 symptoms graded 0 to 4. The Australian-modified Karnofsky Performance Scale is used to monitor functional state (100 normal, 10 comatose).
Methods:The supportive care clinic was established in conjunction with palliative care, attended by a nurse practitioner, social worker, nephrologist, and palliative care physician. Over 12 months, 53 patients from existing nephrology clinics were referred (41 attended, 12 had telephone contact with the nurse practitioner and social worker). Patients who attended the clinic were included in the analysis.
Results:51% were males, median age 81years (35–98). The commonest causes of ESKD were diabetic nephropathy (42%) and hypertension/renovascular disease (32%). 34 patients completed the POS-S Renal. The most common symptoms reported were poor mobility 85%, weakness 79%, pain 59%, difficulty sleeping 59%, and itch 53%. The median Karnofsky score was 60. In the 12-month period 18 patients died, 56% in own residence or palliative care facility.
Conclusions:The multi-disciplinary SCC met the needs of patients and carers. The main patient symptoms were poor mobility, weakness and pain, with psychosocial support needed in most cases. Future plans aim to include dialysis patients with significant symptom burden/considering cessation of dialysis. Funding and logistical issues remain ongoing barriers to sustaining renal SCCs.
Professor Peter Kerr is the Director of Nephrology at Monash Health. He is a Council Member of the ISN and APSN, and a former Editor-in-Chief of “Nephrology”. He maintains a strong research interest in numerous areas of nephrology, most notably haemodialysis and home based therapies.