#4446 THE CARE TRAJECTORY LEADING TO EMERGENCY DIALYSIS START: CROSSING PATIENTS’, GENERAL PRACTITIONERS’ AND NEPHROLOGISTS’ PERSPECTIVES

Abstract

Abstract Background and Aims Emergency dialysis start (EDS) is an important issue to understand and tackle in CKD care. Late referral, absent previous nephrology care and higher comorbidity scores have been associated with EDS. However, how those quantitative risk factors happen and contribute to EDS remains unexplored. We conducted a qualitative study in France to identify and describe the mechanisms that shape the trajectories that lead to EDS, using patients, GPs and nephrologists perspectives. Method Three groups of participants were recruited in Brittany, north-west France: Patients who started dialysis in emergency between 2017 and 2019, GPs and nephrologists. Maximum variation sampling approach was used based on patients’ socio-economic profiles and GPs’ and nephrologists’ years and settings of practice. Semi-structured interviews were conducted between 2017 and 2020. A crossed thematic analysis between the 3 groups of transcripts was performed, informing how EDS trajectories come to be. Results Twenty patients, 12 GPs and 18 nephrologists were interviewed. Five main themes were identified: 1) Learning about dialysis, 2) Dialysis and nephrology care representations: a) an unacceptable biographical disruption, b) a dreadful invasive machinery, c) a straw that breaks the camel's back, 3) The gap between the “illness” perceived and the “disease” treated, 4) Slipping through the primary care prevention net, 5) the unavoidable unpredictability of CKD course. Conclusion This study shows how quantitative risk factors of EDS such as low or absent previous nephrology care are, in part, the results of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology. The results suggests a need for evaluation of kidney replacement therapy education programs and reinforcement of psychological care. Finally, results also support ambitious mass prevention campaign focused on kidney health to counter the persistent negative representation of dialysis and seal off prevention cracks younger patients slip through.