Abstract: SA-PO1113
Longitudinal Study of Conservative Kidney Management by Using Tools to Identify Palliative and End-of-Life Care Needs
Session Information
- CKD: Patient-Oriented Care and Case Reports
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Seow, Ying-ying, Sengkang General Hospital, Singapore, Singapore
- Teh, Swee Ping, Sengkang General Hospital, Singapore, Singapore
- Lee, Ivan Wei Zhen, Sengkang General Hospital, Singapore, Singapore
- Cheng, Koey, Lee Kong Chian School of Medicine, Singapore, Singapore, Singapore
- Lee, Angelica, Lee Kong Chian School of Medicine, Singapore, Singapore, Singapore
- Yeoh, Lee Ying, Sengkang General Hospital, Singapore, Singapore
Background
Trajectory of end-stage kidney disease (ESKD) patients on conservative care varies. The objective of study was assessing the utility of objective assessment tools and mortality outcome.
Methods
This is a single center, prospective study of conservative kidney management patients from April 2021 to February 2024. Palliative trained community nurse performed monthly home visit and assessment. Edmonton symptom assessment system revised (ESASr version 2016), resource utilization groups activities of daily living (RUG-ADL) and palliative performance scale (PPS) were used and monitored longitudinally. SPSS version 27 was used for analysis, p < 0.05 is considered significant.
Results
A total of 103 patients with median follow-up of 11.1 months (IQR: 0.4, 15.8). Forty-seven patients passed away during the study. The baseline characteristics including female 64.1%, Chinese 80.6%, mean age 79.6±7.7 years, estimated glomerular filtration rate 10.5±3.4ml/min and Charlson comorbidity index 8.4±1.9. No significant difference between the survived versus demised group. However, those demised patients had higher ESASr (4.4 vs 2.0), RUG-ADL (6.3 vs 4.9) but lower PPS (59 vs 67) at baseline.
Mixed model using repeated measurements for ESASr, RUG-ADL and PPS were done. The variance within each time point for RUG-ADL, ESASr and PPS were 1.5, 6.5 and 27.4, whereas covariance between any 2 time-points were 7.2, 11.3 and 136.9 respectively. There was no interaction with PPS model. The CKM patients have relative stable PPS until last few weeks of life (figure1).
Conclusion
This study demonstrated the high degree of symptom burden and functional decline toward the end of life for CKD patients managed conservatively. Optimal community care allow close monitoring of symptoms with optimization of care and timely referral to hospice service to reduce hospitalization for end-of-life care.
Funding
- Government Support – Non-U.S.