Kidney supportive care for advanced chronic and end-stage kidney disease: a retrospective cohort study.

Abstract

Kidney supportive care is an interdisciplinary model of person-centred medicine, suitable for patients with advanced Chronic Kidney Disease (CKD) and with End-Stage Kidney Disease (ESKD). There is little information on routine care, and palliative careremains poorly integrated into standard nephrology care. The aim of this study was to describe our experience in integrating a palliative care approach into the nephrology care of advanced chronic and end-stage kidney disease. A retrospective cohort study was conducted from 1 June, 2017 until 31 December, 2020 on 67 advanced CKD and ESKD patients admitted to a palliative care service. The patients' median age was 83.6years, 62.7% were male, 16.4% had CKD stage 4 and 83.6% stage 5. Almost half (47.8%) of the patients were on kidney replacement therapy, and 52.2% were on conservative therapy. The majority (77.6%) received home-based palliative care, 17.9% hospice care and 4.5% day-hospice care. The median number of nephrologists' visits per patient was 3.5. Access to palliative care specialists was set at 100% and the median number of palliative clinicians' visits was 8. Eighty-five percent of patients did not require hospitalisation and 94% did not access to theemergency room; 86.2% of the patients died in hospice or at home. This study reports onthe first stepstaken to change practice in nephrology, by applying the Italian guideline for an integrated pathway of palliative carein nephrology. Nephrologists' and the palliative careteam created a multi- and inter-disciplinary team, sharing their professional skills to support patients in hospice or at home.