EVALUATING AND OPTIMISING THE DELIVERY OF KIDNEY SUPPORTIVE CARE

L PURTELL1,2,3, HG HEALY2,3,4, A BONNER1,2,
31Faculty 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 identify successful strategies used in optimising the implementation of a kidney supportive care (KSC) program.
Background: KSC offers effective interdisciplinary care to people with advanced stages of kidney disease to relieve symptoms and/or psychosocial distress. However, KSC represents a significant cultural change from traditional quantitative-based nephrological models of care. For the care pathway to be successfully implemented within these traditional models, it needs to be responsive to the local culture.
Methods: A KSC program was introduced into a hospital-based networked kidney service with no history of such a care pathway, and its implementation was evaluated using an implementation science framework (the Consolidated Framework for Implementation Research [CFIR]). Eighteen clinical and executive staff members connected to the program were interviewed and qualitative content analyses, based on the CFIR, were performed to identify factors in the program’s implementation.
Results: Stakeholders identified i) short-term limited funding creating anxiety around sustainability and difficulties in future planning; and ii) unfamiliarity with the concept of kidney supportive care as barriers to implementation. The embedded implementation team, comprising researchers and clinicians, responded by demonstrating clinical and patient-reported outcomes of the program and embarking on a campaign of engagement with clinicians referring into the program and executive decision-makers in the organisation. One outcome was successful transition to permanent funding. Other outcomes include local and national awards for research excellence, clinical excellence and patient safety.
Conclusions: The methodology of implementation science is a robust approach to recognising and addressing challenges in the important domain of managing key stakeholders. The data we obtained allowed us to refine the implementation, as it was proceeding, of a new care pathway for patients.


Biography:
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.

YOUNGER ADULTS ALSO REQUIRE KIDNEY SUPPORTIVE CARE

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.


Biography:
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.

PREDICTING IMPROVEMENT IN HEALTH-RELATED QUALITY OF LIFE IN PEOPLE RECEIVING DIALYSIS: THE LEOPARD STUDY

L PURTELL1,2,3,  B HIREMAGALUR4,  PM SOWA3,5,  L BUBLITZ4,  A BONNER1,2,3
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, 4Department of Nephrology, Gold Coast University Hospital, Gold Coast, Australia, 5Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia

Aim: To determine factors predicting health-related quality of life (HRQoL) at baseline and over time in adults receiving dialysis.
Background: Many people receiving dialysis to manage end-stage kidney disease report poor HRQoL and burdensome symptoms. However, it is not clear whether these measures are sensitive to reciprocal, clinically meaningful changes. We investigated the relationship between changes in HRQoL and symptoms using validated patient-reported assessment tools.
Methods: Adults receiving dialysis completed the EQ5D-5L and POS-S questionnaires 3-monthly to assess overall HRQoL (visual analogue score) and symptom burden (total POS-S score), respectively. Additional data (gender, age, Charlson comorbidity score, functional performance (Australia-modified Karnofsky Performance Scale) and treatment modality (in-centre haemodialysis [HD], home HD or peritoneal dialysis [PD]) were extracted from hospital records and ANZDATA registry. Factors predicting HRQoL were determined using multiple linear regression. For HRQoL and symptom burden, the minimal clinically important difference (MCID) was estimated at ½*standard deviation (9.3 for HRQoL and 4.6 for symptom burden).
Results: 177 people receiving either HD or PD (31% female, median age 65 [range 19‒91]) were included for analysis. At baseline, while gender, comorbidity score, age, treatment modality, symptom score and functional performance explained 32% of the variation in HRQoL overall, only symptom score and functional performance contributed significantly (both p<0.001). The relationship between MCID changes from baseline to 6 months in HRQoL and symptom scores was explored in those who participated for ≥6 months (n=165). Within this sub-group, MCID improvement in symptom scores strongly predicted MCID improvement in HRQoL (p<0.001).
Conclusions: Improved symptom management of people receiving dialysis to a clinically meaningful extent, facilitated by routine clinical assessment, may have beneficial effects on overall HRQoL.


Biography:
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.

CHRONIC KIDNEY DISEASE: WHO ARE THE HIGH COST USERS OF HOSPITAL CARE?

PM SOWA1,2, J ZHANG1,3, A CAMERON1,3, HG HEALY1,3,4, WE HOY1,3, LB CONNELLY1,2
1NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Australia, 2Centre for the Business and Economics of Health, The University of Queensland, Woolloongabba, Australia, 3Faculty of Medicine, The University of Queensland, Herston, Australia, 4Kidney Health Service, Metro North Hospital & Health Service, Queensland Health, Herston, Australia

Aim: To investigate characteristics and utilisation patterns of high-cost users (HCUs) of hospital care relative to non-HCU in patients with chronic kidney disease (CKD).
Background: CKD places a considerable burden on health care system resources, particularly on hospitals. In much medical data a small group of heavy users account for a disproportionately large share of expenditures. We retrospectively identified and characterised high-cost users (HCUs) of hospital care within a CKD cohort.
Methods: We analysed variables in HCU and non-HCU groups in patients from the CKD.QLD Registry, and their hospital admission records supplied by Queensland Health. We considered utilisation within 12 months after patients’ consent to the Registry. Those without a complete 12-month record were excluded from the analysis.
Results: Among 5,631 individuals, the top 10% of the most costly HCUs accounted for 71% of expenditures on admitted hospital care. 53% of the HCUs were frequent users (i.e. had more than 4 admissions for reasons other than dialysis). Dialysis accounted for 16% of expenditures within the HCU group and for 3% in other patients. HCUs were more likely to be male (59%vs54% non-HCU), to have advanced CKD (stages 4/5: 51%vs30% non-HCU) and to have comorbidities (diabetes and/or CVD: 78%vs62% non-HCU). HCUs also had considerably longer average lengths of stay (7.1 vs 2.3 days) and were more frequently admitted following an emergency presentation (49% of HCUs vs 43% of non-HCUs). One in 20 HCUs at year one remained HCU over 5 years.
Conclusions: These data allow identification of areas of high costs, and may inform design of clinical, epidemiological and policy responses. Data on nonsurvivors to one year, the likely highest costs users, are under analysis.


Biography:
Dr Marcin Sowa is a Postdoctoral Research Fellow at the University of Queensland Centre for the Business and Economics of Health, and a health economist in the NHMRC Chronic Kidney Disease Centre of Research Excellence. Dr Sowa has led research projects in the areas of health care financing and insurance, health system governance, comparative healthcare systems, public health policy and, more recently, chronic kidney disease. He is a lecturer and course coordinator in health technology assessment and economic evaluation, and a member of the Medical Services Advisory Committee Evaluation Sub-committee (MSAC-ESC).

PATIENT REPORTED OUTCOME MEASURES IN AUSTRALIAN AND NEW ZEALAND RENAL UNITS: AN ANZDATA SURVEY OF CURRENT PRACTICE

RL MORTON1,  N LIOUFAS2,3,  K DANSIE4,5, S PALMER6, M JOSE7,R RAJ8,  A SALMON9, M SYPEK4,10,  A TONG11,  M LUDLOW12, N BOUDVILLE13,  S MACDONALD4,5,14
1NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia, 2Department of Nephrology, Western Health, Sunshine Hospital, St Albans, Australia, 3Western Clinical School, School of Medicine, The University of Melbourne, Melbourne, Australia, 4Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, Australia, 5University of Adelaide, Adelaide, Australia, 6University of Otago Christchurch  , Christchurch, New Zealand, 7School of Medicine, University of Tasmania , , Australia, 8Launceston General Hospital, Launceston, Australia, 9Renal Service, Waitemata District Health Board, Auckland, New Zealand, 10Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia, 11Sydney School of Public Health, Sydney Medical School, The University of Sydney,,  Camperdown, , Australia, 12Kidney Health Australia, Adelaide , Australia, 13Sir Charles Gairdner hospital, Perth, Australia, 14Central and Northern Renal Transplant Service, Royal Adelaide hospital, Adelaide, Australia

Aim: The Australia New Zealand Dialysis and Transplant registry (ANZDATA) PROMs Working Group sought to characterise current practices for measurement and use of PROMs in Australian and New Zealand renal units and gauge interest in registry-based PROMs collection.
Background: Patient-reported outcome measures (PROMs) are increasingly used in research studies to quantify how patients feel and function, but their use in routine nephrology care is infrequently described.
Methods: Cross-sectional survey of Australia/New Zealand ‘parent’ renal units. One survey per unit was completed via email or telephone interview (August–November 2017). Descriptive statistics and regression models determined the factors associated with PROMs collection, treatment groups measured, instruments used and purpose for collection.
Results: Survey response rate was 100%. Thirty-nine of 79 units (49%) ascertained at least one PROM, strongly associated with the unit’s jurisdiction (p<0.001) and public versus private status (p<0.001). PROMs were more likely to be ascertained among patients receiving conservative care (45% of units) than dialysis patients (32%, 31% and 28% of units for home haemodialysis, peritoneal dialysis and facility dialysis, respectively) or transplant patients (3%). The Palliative Outcome Scale instruments (IPOS-Renal and POS-S) (65% of units), and the Euro-Qol (EQ-5D-5L) (25%) were most frequently used. The main reason for collecting PROMs was to inform clinical care (58%). The most commonly reported reason for not using PROMs was insufficient staff resources (79%). Sixty-two units (78%) expressed interest in participating in a registry-based PROMs trial.
Conclusions: Approximately half the renal units in Australia and New Zealand collect PROMs as part of clinical care with use varying by treatment modality. Resources are a key barrier to ongoing PROMs collection. There is considerable interest in a registry-based PROMs trial.


Biography:
Associate Professor Rachael Morton, MScMed(Clin Epi)(Hons), PhD, is Director of Health Economics at the NHMRC Clinical Trials Centre, University of Sydney. She is an academic health economist and clinical trialist with research interests in patient reported outcomes and economic evaluation of interventions in chronic kidney disease and cancer. A/Prof Morton leads the ANZDATA PROMs Working Group, and is an Executive member of the ANZSN Dialysis Advisory Committee. She has over 100 publications and currently holds an NHMRC Translating Research Into Practice (TRIP) Fellowship to embed patient reported outcomes into clinical quality registries.

SYMPTOM BURDEN AND EUROQOL EQ-5D-5L UTILITY-BASED QUALITY OF LIFE FOR AUSTRALIAN PATIENTS WITH END-STAGE KIDNEY DISEASE RECEIVING RENAL SUPPORTIVE CARE: PRELIMINARY RESULTS FROM A PROSPECTIVE STATEWIDE COHORT ANALYSIS

RL MORTON1, A HOFFMAN2, E JOSLAND2,  C COUCHOUD3,  M BROWN2,4
1Nhmrc Clinical Trials Centre, The Universty of Sydney, Camperdown, Australia, 2St George Hospital, NSW, , Kogarah, , Australia, 3National French ESRD registry REIN, French Agence de la biomedicine, Paris, France, 4University of New South Wales, Randwick, Australia

Aim: To assess symptom burden and quality of life at referral to Renal Supportive Care services.
Background: The NSW Renal Supportive Care Service is a networked statewide service that integrates palliative care into existing renal services for conservative care, dialysis, pre-dialysis and transplanted patients.
Methods: Symptom burden was measured using the Integrated-Palliative Outcome Scale–Renal (IPOS- Renal) for 15 +/-3 symptoms (on a 0-4 scale, not at all to overwhelming). Quality of life (QOL) was measured with the EuroQol (EQ-5D-5L) questionnaire (0-1 scale, death to full health) at each clinic visit. Means with standard deviations (SD) are presented by treatment pathway.
Results: Of 1255 patients from 22 renal units, between January 2016-September 2017, 353 (28%) completed the EQ-5D-5L questionnaire, mean age 78 years. 49% were on a conservative (non-dialysis) pathway, 38% dialysis, 7% pre-dialysis, 3% transplant, and 3% pathway unrecorded. Considering the maximum symptom burden values for each patient, the mean IPOS-Renal score was 19.43 (SD 9.69). The mean EQ-5D-5L QOL was 0.45 (SD 0.39); and by treatment pathway was 0.49 (SD 0.36) for conservative care (n=174); 0.41 (SD 0.42) for dialysis (n=135) [difference in means not significant p=0.0689]; 0.47 (SD 0.40) pre-dialysis (n=24); 0.30 (SD 0.47) transplant (n=10); and 0.61 (0.42) for those with a pathway unrecorded (n=10). At baseline, mobility, pain, and usual activities dimensions were responsible for the greatest decrement in QOL.
Conclusion: Patients referred to this service experience high symptom burden and poor QOL regardless of treatment pathway. Interventions that target mobility, pain and usual activities dimensions may improve overall QOL. These baseline estimates are essential for calculating the economic benefit of renal supportive care services for patients with ESKD.


Biography:
Associate Professor Rachael Morton, MScMed(Clin Epi)(Hons), PhD, is Director of Health Economics at the NHMRC Clinical Trials Centre, University of Sydney. She is an academic health economist and clinical trialist with research interests in patient reported outcomes and economic evaluation of interventions in chronic kidney disease and cancer. A/Prof Morton leads the ANZDATA PROMs Working Group, and is an Executive member of the ANZSN Dialysis Advisory Committee. She has over 100 publications and currently holds an NHMRC Translating Research Into Practice (TRIP) Fellowship to embed patient reported outcomes into clinical quality registries.

EARLY EVALUATION OF AN INNOVATIVE PAEDIATRIC NEPHROLOGY SERVICE IN THE NORTHERN TERRITORY OF AUSTRALIA: A CARER’S AND PROVIDER’S PERSPECTIVE

S CHATURVEDI1,3, J HUGHES2,3, C SAJIV2, P MORRIS1,3
1Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia, 2Department of Renal Medicine, Royal Darwin Hospital, Darwin, Australia, 3Menzies School of Health Research, Darwin, Australia

Aim: To use the “paediatric nephrology service carer and health provider survey” to inform clinical practice in a high burden, limited resource setting.
Background: The Northern Territory (NT) has extremely high rates of kidney disease. Surprisingly, there was no paediatric nephrology service prior to March 2017. We have introduced a part-time paediatric nephrology service covering weekly ambulatory care clinics, collaborative clinics with visiting inter-state urologists, inpatient consultations, and renal biopsies.
Methods: Healthcare providers were sent an online survey in March 2018. The carers completed the survey during clinic appointments. The 9 questions were designed to assess: general demographics, service accessibility, and service quality. It took 2-3 minutes to complete.
Results: Overall, 30 carers and 42 healthcare providers completed the survey. Most carers (26/30) were parents.  Fourteen carers were Caucasian and 8 were Aboriginal. All the carers strongly agreed that interactions with the paediatric nephrology service have significantly improved the care of their child. It also helped them gain a better understanding of treatment options. Specific feedback included positive comments on improved team work and better communication among key stakeholders.  Among healthcare providers, 15/42 (36%) were paediatricians and the remainder were nephrologists, nurses and paediatric surgeons. 95% of the responders expressed a high degree of satisfaction with availability and the provision of an on-site paediatric nephrology service. Specific feedback acknowledged the need for augmenting and sustaining a dedicated paediatric nephrology service for the NT.
Conclusions: The survey indicates a high degree of satisfaction with the newly established paediatric nephrology service. We will continue to monitor our progress as we now focus on providing a more comprehensive and integrated service for the whole of the Territory.


Biography:
Dr Swasti Chaturvedi is a Paediatric Nephrologist at the Royal Darwin Hospital and visiting Paediatric Nephrologist at Alice Springs Hospital. She is also Senior Lecturer (Adjunct) in College of Medicine and Public Health, Flinders University

 

Twitter: @SwastiThinks

INDIGENOUS PATIENT EXPERIENCES OF RETURNING TO COUNTRY: A QUALITATIVE EVALUATION OF THE COUNTRY HEALTH SA DIALYSIS TRUCK

J CONWAY1, S LAWN2, S CRAIL1,3, S MCDONALD1,3
1Royal Adelaide Hospital, Adelaide, Australia, 2Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, Bedford Park, Australia, 3Central Adelaide Renal and Transplantation Service, Adelaide, Australia

Aim: To qualitatively evaluate the impact of the South Australian Mobile Dialysis Truck program on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service.
Background: Many Indigenous Australians from remote areas with End-Stage Kidney Disease relocate to metropolitan centres to access regular haemodialysis. The SA Mobile Dialysis Truck was designed to address this dislocation from family and country, providing opportunities to reunite patients with friends and family by visiting remote communities for one to two weeks.
Methods: Face to face semi-structured interviews occurred with 15 Indigenous dialysis patients and 10 nurses across seven dialysis units who had attended trips. Realist evaluation methodology and thematic analysis sought patient and nursing experiences.
Results: The consequences of leaving country included grief and loss. Lower trip frequency, poor advertisement and lack of accommodation for staff and patients and poor health were barriers to attendance. Benefits included fulfilment of cultural commitments; minimisation of medical retrievals from remote areas; improved trust and relationships between patients and staff and improved patient quality of life. The truck provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role.
Conclusions: The Dialysis Truck improved the social and emotional wellbeing of Indigenous patients who relocated for dialysis and built positive relationships and trust between metropolitan nurses and remote patients fostering improved engagement. It also provided valuable cultural learning opportunities for nursing staff.


Biography:
I am currently working as an Advanced Trainee in Renal Medicine at the Royal Prince Alfred Hospital having previously worked at the Royal Adelaide Hospital. I am a qualitative researcher with interests in rural and remote health, in particular Indigenous health.

WHAT IS RENAL SUPPORTIVE CARE? RESULTS FROM A SURVEY OF CLINICIANS’ VIEWS AND EXPERIENCES IN AUSTRALIA AND NEW ZEALAND

K DUCHARLET1,2,  J PHILIP1, H GOCK1,2
1St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Melbourne University, Parkville, Australia

Aim: To understand renal clinicians’ views and experiences of Renal Supportive Care (RSC) and Specialist Palliative Care (SPC).
Background: Patients with end stage kidney disease (ESKD) report high symptom burden, complex care needs and have a limited prognosis.   RSC is an evolving clinical approach integrated within existing renal services aiming to improve quality of life (QOL).  Clinicians’ perceptions of RSC and its role alongside that of SPC are unknown.
Methods: A cross-sectional validated online survey was undertaken between February and May 2018. Participants completed demographic details, views on RSC and SPC and elements of an “ideal model of RSC.”
Results: Of the 356 clinicians completing the survey, 78% were female, 59% nurses, 29% doctors, 69% metropolitan, 81% had SPC access, 59% RSC access with variability in reported activities of current RSC services.   RSC was seen as improving symptoms and QOL (90%), different to SPC (78%), a more acceptable term than palliative care (80%).Participants suggested ideal RSC should include;

  • symptom management (98%),
  • improved integration between nephrology and community healthcare services (97%) and community SPC (93%),
  • improved clinician RSC education (94%),
  • RSC coordinator (91%),
  • complex treatment decision making (90%),
  • defined pathway for conservative patients (86%).

Clinicians were more likely to consider referral to RSC over SPC for symptoms, (85%vs78%,p=0.013), withdrawal from dialysis (94%vs87%,p=0.001), complex treatment decision making (84%vs59%,p=0.000), but SPC was favoured if the patient was dying (76%vs96%,p=0.000).

Conclusions:RSC is viewed as highly acceptable with a role in improving symptoms and QOL for renal patients. Widespread variation of current experience and access exists.  This study revealed opportunities to improve new and existing services to assist ESKD patients.


Biography:
Kathryn is a Nephrologist and PhD candidate with active clinical and research interests in CKD, Renal Supportive Care and Palliative Care.

SETTING UP A METABOLIC KIDNEY STONE ASSESSMENT CLINIC – THE AUCKLAND CITY HOSPITAL EXPERIENCE

E CURRY1,  L LLOYD1, C JORDAN2, S LOEFF3, M RICE1, J COLLINS1
1Auckland City Hospital, Grafton, New Zealand, 2University of Auckland, Auckland, New Zealand, 3Universitair Medisch Centrum Groningen, Groningen, Netherlands

Aim: To audit and improve the management of patients with kidney stones presenting to Auckland City Hospital
Methods: A retrospective audit of patients presenting to Urology with acute kidney stone events from July 2014 – July 2015 was undertaken.  This demonstrated that most patients at risk for recurrent stones were not subsequently screened metabolically or referred to nephrology.  A  stones clinic was established and a further  audit was undertaken.
Results:1328 stone event were recorded from July 2014 – July 2015.  56% of patients were classified as being at high risk for further events.  Only 14% of high-risk patients had any 24 urine collections performed and fewer than 5% saw a dietician.Following this a metabolic stone assessment clinic was developed.  Set referral criteria and referral processes were implemented including the development of standard 24 hour urine collection forms, patient information and instruction sheets and an Emergency department referral form. The clinic was audited from September 2016 – September 2017.  A total of 52 patients were seen over this time with appointment numbers showing a progressive rise over time.  34.8% of patients had complete blood tests carried out and 30% had the recommended three 24 hour urine collects prior to the first review, the remainder completed investigations after the first review. 92% of patients received dietary advice and 21.2% were prescribed medication.
Conclusions: The introduction of a standard process has resulted in major improvement in the assessment and management of high-risk stone formers. Ongoing efforts are required to ensure that all patients at risk for recurrent stone formation are referred.  New strategies have been implemented and a further audit of practice and results is planned.


Biography:
Dr Elizabeth Curry is a general nephrologist at Auckland City Hospital.  She has interests in kidney stones, CKD and haemodialysis.  She has been involved the set up of a new metabolic stone assessment clinic in Auckland, New Zealand.

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