Kidney Week

Abstract: PUB127

Improving Dialysis Initiation in Stage 5 CKD: A Quality Improvement Project at a Safety Net Hospital

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Oldford, Elaine J., Los Angeles General Medical Center, Los Angeles, California, United States

Elaine J. Oldford, MD

• Khine, Annika K., Los Angeles General Medical Center, Los Angeles, California, United States

Annika K. Khine, MD

Background

At Los Angeles General Medical Center (LAGMC), a large safety net training institution, residents and fellows rotate through specialty clinics, serving a primarily Hispanic and underserved population. In LAGMC renal clinic, we implemented a quality improvement project in patients with eGFR <20 ml/min/1.73m2, by scheduling them in an attending-directed CKD clinic rather than with resident trainees for follow-up visits. This study evaluates the impact of this intervention on inpatient and outpatient dialysis initiation and the use of permanent dialysis access.

Methods

In this retrospective observational study, medical records of 244 CKD Stage V patients at LAGMC renal clinic from January to July 2022 were reviewed. We determined the endpoint for each patient as dialysis initiation (inpatient or outpatient) or the end point date of February 2024 if not yet on dialysis. The intervention began in October 2022, transferring patients from resident panels to attending panels for follow-up visits, with a 3-month run-in period.

Results

167 of patients initiated dialysis, with 105 (63%) as inpatient and 62 (37%) as outpatient. There was a decreasing trend in inpatient initiations and an increasing trend in outpatient initiations over time. Inpatient dialysis initiations resulted in an average hospital stay of 7 days, with 22% of patients requiring temporary dialysis catheters. There was also an increase in permanent vascular access (AVF/AVG) over time of CKD Stage V patients at the endpoint.

Conclusion

Quality improvement that have CKD Stage V patients seen directly by attending nephrologists can decrease the rates of inpatient "crash" start dialysis and increase vascular access.

Access Type Present at End Point