Kidney Week

Abstract: SA-PO1117

Preemptive Outpatient Clinic Experience: Holistic Approach vs. Standard of Care

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

• Sivo, Carmen, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Carmen Sivo, MD

• Guido, Raffaella, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Raffaella Guido, MD

• Cataldo, Emanuela, Poliambulatorio Altamura, Altamura, Puglia, Italy

Emanuela Cataldo, MD

• Russo, Ilario, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Ilario Russo, MD

• Annese, Francesca, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Francesca Annese, MD

• Acquaviva, Paola Maria, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Paola Maria Acquaviva

• Rana, Gloria, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Gloria Rana

• Caggiano, Gianvito, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Gianvito Caggiano, PhD

• Fiorentino, Marco, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Marco Fiorentino, MD

• Mitrotti, Adele, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Adele Mitrotti, MD

• Gesualdo, Loreto, Universita degli Studi di Bari Aldo Moro, Bari, Puglia, Italy

Loreto Gesualdo, DrMed

Background

Pre-emptive kidney transplantation (PKT) represents the best option of renal replacement therapy (RRT), but it is still underused.

Methods

We analyzed lab parameters at baseline, at the last follow-up and RRT initiation outcomes in a cohort of 404 chronic kidney disease (CKD) patients with G4-G5 KDIGO-stages, afferent to pre-emptive outpatient clinic at Policlinico of Bari (Apulia, Italy), from January 2017 to January 2024. Inclusion criteria: age within 18 e 80 years, eGFR CKD-EPI < 30 ml/min. We compared different parameters of CKD progression in a group of patients treated with a multidisciplinary holistic approach (that included a nutritional and psychological counseling) and a group of patients managed with standard of-care approach.

Results

Patients (262 M and 142 F) had a mean age of 55 years, with follow-up mean timing of 686,3 days. Of the 404 patients, 139 started hemodialysis, 122 are still in follow-up, 69 chose peritoneal dialysis, 43 underwent PKT, of which 36 from living donors and 7 from deceased donors, while 23 were lost at follow up and 8 died. Patients treated with multidisciplinary holistic approach (N=73) had a lower cumulative probability of initiating RRT (LogRank test: p=0.003) rather than the standard of care group (Fig. 1). Specific nutritional approach was associated with a significative azoturia reduction in the holistic group (15,5 vs 20,3 g/24h); while the use of music- therapy intervention determined a reduction in anxiety and tiredness patients’ perception.

Conclusion

Multidisciplinary approach could represent an opportunity to slow CKD progression and increase the number of PKT. These preliminary data lay the foundations for a careful management of advanced CKD patients.