Management Of Kidney Disease Research Articles

Equity in national policies for Australians with kidney disease

ObjectiveTo describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). MethodsWe searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. ResultsWe included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. ConclusionCKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public healthIn Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.

Nationwide questionnaire survey on the management of chronic kidney disease for general practitioners in Japan.

In 2019, a nationwide questionnaire survey on the management of chronic kidney disease (CKD) was circulated to general practitioners (GPs) throughout Japan by The Japan Physicians Association. The aim was to assess the current state of CKD medical care in the country and evaluate the utilization of CKD-specific guidelines in the treatment by GPs. The voluntary survey targeted all members of Japan Physicians Association, a nationwide organization consisting primarily of 15,000 GPs in clinics throughout the country. GPs were divided into groups: 171 GPs using and 414 GPs not using the guidelines. Comparisons between the groups' responses were made using propensity score matching and component cluster analysis. Overall responses revealed that the estimated glomerular filtration rate's utilization rate was high (95.1%). However, evidence-practice gaps in urine protein quantification and anemia remedy were prominent. There were significantly favorable answers in terms of CKD management in the user group compared with those in the non-user group, except for the questions about a urine check at the first visit, stopping the use of renin-angiotensin system inhibitors, and the target blood pressure for elderly CKD patients. The differences suggest that utilization of the CKD guidelines has improved CKD management practices by GPs. Further promotion of CKD guidelines utilization (28% in this survey) is considered valid for CKD medical education.

A systematic review on nephron protective AYUSH drugs as constituents of NEERI-KFT (A traditional Indian polyherbal formulation) for the management of chronic kidney disease.

Chronic Kidney Disease (CKD) is a major health problem characterized by kidney dysfunction with progressive segmental glomerulosclerosis to end-stage renal disease (ESRD). Due to lack of scientific data and comprehensive reports, the current systematic review provides an inclusive understanding and prospective associated with phytopharmacology of NEERI-KFT in CKD. The data was collected from more than five databases such as Science Direct, Google Scholar, Elsevier, PubMed, Springer, ACS publication etc using keywords like CKD/Kidney disease, epidemiology/prevalence, modern therapies for CKD management, NEERI-KFT and its role in kidney disease. The study was performed based on scientific reports screened by experts according to inclusion and exclusion criteria. The pre-clinical and clinical findings suggested that NEERI-KFT has promising effects as nephroprotective and considered safe and well effective in primary care of kidney against disease. Phytopharmacological evaluation of NEERI-KFT suggest that it exhibit substantial potential against oxidative and inflammatory stress induced apoptosis by exerting antioxidants, nephroprotective and immunomodulatory effects. Hence, it can be enlighten that NEERI-KFT have potential herbs which exerts significant antioxidants, nephroprotective and immunomodulatory effects in the patients associated with renal dysfunction or CKD thus improving altered renal architecture and renal physiology. Clinically, it is concluded that NEERI-KFT works kidney malfunction and cease ESRD progression or even reduce the number of dialysis.

Why the incidence in dialysis in the Lisbon and Tagus Valley Region (LVTR) is two to three times higher than in other regions of the country

The analysis of data from the Ministry of Health’s Integrated Chronic Kidney Disease Management Platform (PI -GID), reveals the existence of a striking regional difference in the incidence in dialysis. This difference is characterized by high levels of incidence in all regions, except the Alentejo, and extremely high levels in the Lisbon and Tagus Valley region. In this region, the incidence values are two to three times higher than in the others. The difference between regions is the result of a different number of patients starting hemodialysis, since the incidence in peritoneal dialysis is low and similar in all of them. It is difficult to find justification for such a discrepancy since the prevalence of factors usually responsible for the higher or lower level of incidence in dialysis does not differ significantly between them. A probable explanation may lie in the difference found in the concentration of public hemodialysis centers, a fact that may determine a difference in the criteria used for the entry of patients undergoing substitutive treatment of renal function. In fact, we found a close correlation between the number of public hemodialysis centers per million inhabitants and the level of incidence in dialysis. A more comprehensive analysis of the data from the Ministry of Health’s Integrated Chronic Kidney Disease Management Platform (PI -GID), if allowed, would be of enormous interest, not only to explain this discrepancy in the incidence of dialysis between regions, but because it could probably allow an explanation for Portugal having (one of) the highest levels of dialysis incidence in Europe

Kidney Transplantation and Monoclonal Gammopathy of Undetermined Significance

Plasma cell disorders are one of the most common hematologic malignancies. Monoclonal gammopathy of undetermined significance (MGUS) is defined by a serum monoclonal protein <3 g/dL, bone marrow plasma cell infiltration <10%, and most importantly absence of end-organ damage. The prevalence of MGUS in general population is estimated to be 1%-4% and its frequency increases with age with 3% among people above 50 y of age. The risk of progression to clinically significant plasma cell dyscrasia is estimated to be 1% per year. With aging population and increasing use of transplantation for the management of kidney disease in older adults, MGUS is being identified during the evaluation for kidney transplant candidacy or during the postkidney transplant follow-up. MGUS in patients with end-stage renal disease (ESRD) undergoing evaluation for kidney transplant can pose a complex management dilemma. In this article, we review the current state of knowledge about the prevalence of MGUS in ESRD population and the impact of kidney transplantation on the progression of MGUS to clinically significant plasma cell disorder. We make recommendations for the screening of ESRD patients undergoing kidney transplant evaluation and the management of MGUS after renal transplant.

Insertion of Trocar into the Cyst for Laparoscopic Management of Hydatid Kidney Disease

Abstract Introduction: Renal hydatid cyst operation is usually performed laparoscopically.1–3 In the laparoscopic treatment of the liver hydatid cysts' various methods of entry and drainage are use...

Self Support Group for Chronic Renal Failure Patients

Self-support groups bring the patients together who is suffering from the same kind of disease conditions or problems or illnesses to share their experiences. Chronic renal failure patients and other illness support groups are a growing need in many communities.&#x0D; When planning for the management for CKD (Chronic Kidney Disease) patient, if involve the patient or patient is participating actively, it will help in effective management of chronic kidney disease. &#x0D; It may aid in the patient's prognosis and can be postponed in part by self-management. Self-management of Chronic Kidney Disease is complicated due to the progressive nature of the condition and its progression. The management of Chronic Kidney Disease by a self-help group is difficult to assess, particularly over time. SMS (Self-Management Support) is important for this progressive disease because of the special nature of Chronic Kidney Disease self-management. SMS stands for the programmes that health-care providers provide to their patients in order to help them better control of their health. Dissemination of health information, patient education, telephone support, and participation in a support group are all part of you.

Highlights from Studies Presented at the Virtual American College of Cardiology Scientific Sessions 2021: Staying Updated with the Latest Advancements in Prevention.

Purpose of ReviewThis review highlights late-breaking science presented at the Virtual American College of Cardiology Scientific Sessions 2021 that demonstrated advancements in preventative cardiology and introduced novel therapeutic modalities for the management of chronic kidney disease, heart failure, and COVID-19.Recent FindingsThe studies reviewed include clinical trials that assessed the use of dapagliflozin in patients with respiratory failure due to COVID-19 (DARE-19 trial); evinacumab for patients with severe hypertriglyceridemia and pancreatitis; effect of genotype-guided oral P2y12 inhibitors vs conventional clopidogrel on long-term ischemic outcomes after percutaneous coronary intervention (TAILOR-PCI trial); anticoagulation in patients hospitalized with COVID-19 (ACTION trial); atorvastatin vs placebo in patients with COVID-19 admitted to the ICU (INSPIRATION-S trial); rehabilitation therapy in older acute heart failure patients (REHAB-HF trial); and aspirin dosing: a patient-centric trial assessing benefits and long-term effectiveness (ADAPTABLE trial). In addition, we review the results of the American College of Cardiology Global Heart Attack Initiative (GHATI). Finally, we discuss the secondary analysis of the STRENGTH trial assessing the association of achieved levels of omega-3 fatty acid levels and major cardiovascular outcomes.SummaryThe studies presented at the virtual American College of Cardiology Scientific Session 2021 represent remarkable contributions in the field of cardiovascular disease and prevention.

Glucagon-Like Peptide-1 Receptor Agonists-Use in Clinical Practice.

In the past 2decades, eight glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been approved for the management of type 2 diabetes, each with its peculiar molecular structure, pharmacokinetics, and metabolic effects. Along with their marked glucose-lowering actions, which occur both at fasting and in the postprandial phase without an increased risk of hypoglycemia, GLP-1RAs have provided marked reductions in body weight and ancillary improvements in blood pressure and lipid profile. Recent cardiovascular outcome trials have established the benefits of GLP-1RAs on major cardiovascular events and all-cause mortality, independent of glucose control, with minor effects on preventing hospitalization for heart failure. Novel evidence is also emerging on the protection of GLP-1RAs against diabetic kidney disease, mainly preventing the onset of macroalbuminuria. Several mechanisms have been proposed to explain the cardiorenal protective properties of GLP-1RAs, which may be direct or mediated by additional hemodynamic and anti-inflammatory/antioxidant effects. With their favorable cardiometabolic properties and safety profile, GLP-1RAs may offer an ideal pharmacological option for the management of diabetic kidney disease. In this review, we discuss pharmacokinetic properties, glucometabolic effects, and cardioprotective actions of GLP-1RAs, highlighting the available evidence for a kidney protective role and the proposed mechanisms.

Comparative analysis of blind vs real-time ultrasound-guided pediatric renal biopsies: A cross-sectional study

BackgroundRenal biopsy has a definite role in the management of pediatric kidney diseases. Most centers have given up the earlier practice of performing blind biopsy using Tru-Cut needle and started doing real time ultrasound-guided renal biopsy with an automated spring-loaded gun, which has become standard of care in the last decade or so. MethodsWe performed a cross-sectional analysis of the pediatric biopsies conducted at our center over the years by both methods to evaluate whether ultrasound-guided renal biopsy with a disposable automated spring-loaded gun was superior to blind biopsy with a disposable needle of the same size in terms of reduction of complications and improving the yield. We also reviewed the indications and the histopathological diagnosis of pediatric renal biopsies at our center. ResultsA total of 45 native kidney biopsies were performed blind and 48 ultrasound-guided biopsies using the curvilinear probe (frequency 3-5 Hz) of GE Logiq P3 ultrasound machine with disposable spring-loaded automated guns. There was a significant increase in the yield of biopsy in terms of the number of glomeruli per pass. A significant increase in the mean number of glomeruli was noted when a biopsy was performed under ultrasound guidance (P < 0.0001). Gross hematuria was significantly reduced as compared to the earlier biopsies done blind i.e., without ultrasound (P ¼ 0.03). Nephrotic syndrome was the commonest indication for biopsy in our patients during both time periods studied. The most common histopathological diagnosis was MesPGN among the children who underwent kidney biopsy from 2005 to 2007, while Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) were most frequently reported. ConclusionUltrasound guided kidney biopsies in pediatric age group have significant reduction in incidence of post gross hematuria and significant increase in the mean number of glomeruli per pass.

Role of stem cells in the management of acute kidney disease

Background and aim Renal failure is usually treated by hemodialysis forever. Renal transplantation is the only curative intervention. However, regenerative therapies are expected to exert a beneficial role in such situations. The aim of this study was to study the role of mesenchymal stem cells (MSCs) in the treatment of acute renal failure (ARF) in an animal model. Materials and methods ARF was induced by cisplatin injection in 20 male rats weighing 200–225 g. Rats were allocated into one of two equal groups: group A included 10 rats with ARF and umbilical cord-derived stem cell treatment, and group B included 10 rats with saline treatment. In addition, 10 healthy rats were included as a healthy control group (group C). Both serum urea and creatinine were measured after induction of renal failure and on the 7th and 15th day after MSC treatment. Kidney sections were obtained, stained with hematoxylin and eosin, and examined histologically. Results Serum urea and creatinine showed marked elevation after cisplatin injection. These values progressively decreased with MSC treatment significantly. At the end of the second week, the values were near normal. In addition, histological examination of renal section confirms the results obtained by laboratory analysis. Conclusion Umbilical cord-derived MSCs could play a regenerative action in ARF.

Applying Logistic Regression to Predict Diabetic Nephropathy Based on Some Clinical and Paraclinical Characteristics of Type 2 Diabetic Patients

Applying Logistic Regression to Predict Diabetic Nephropathy Based on Some Clinical and Paraclinical Characteristics of Type 2 Diabetic Patients

Transition from a renal paediatric clinic to an adult clinic: Perspectives of adolescents and young adults, parents and health professionals.

The management of chronic kidney disease is complex. With disease management being the responsibility of parents in the paediatric renal clinic, the responsibility is gradually shifted to adolescents and young adults during the transition to adult care. This multi-perspective qualitative study aimed to explore the experiences of adolescents and young adults, their parents and health professionals to gain an insight into transitional care. Focussing on the transition process and transfer to adult care, 18 adolescents and young adults and eight mothers participated in individual semi-structured interviews. Additionally, three focus groups were conducted with 20 multidisciplinary health professionals. Data were transcribed verbatim and analysed thematically. Similar responses from adolescents and young adults and mothers included the reluctance to leave the paediatric health service. Mothers found the transition to adult care more challenging than the adolescents and young adults. While health professionals acknowledged that engaging adolescents and young adults in their own care was challenging, they believed parents had an important role in facilitating their child's independence. This study highlights that health professionals in both paediatric and adult health services need to work collaboratively. However, importantly, health professionals need to be mindful that parents require an equal amount of engagement as adolescents and young adults, if not more, to mitigate parental barriers in achieving a successful transfer.

Population Kidney Health. A New Paradigm for Chronic Kidney Disease Management.

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

Overweight and Obesity and Progression of ADPKD.

On the basis of earlier observations, we evaluated the association between overweight and obesity and rapid progression of autosomal dominant polycystic kidney disease in participants in the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4 trial. More importantly, we also determined whether efficacy of tolvaptan was attenuated in individuals with baseline overweight or obesity. A total of 1312 study participants with relatively early-stage autosomal dominant polycystic kidney disease (mean eGFR 78±22 ml/min per 1.73 m2) who were at high risk of rapid progression were categorized by body mass index (BMI; calculated using nonkidney weight) as normal weight (18.5-24.9 kg/m2; n=670), overweight (25.0-29.9 kg/m2; n=429), or obese (≥30 kg/m2; n=213). Linear and multinomial logistic regression models were used to determine the association of baseline overweight and obesity with change in total kidney volume (TKV) over the 3-year study period. In fully adjusted models, higher BMI was associated with greater annual percent change in TKV (difference of 1.20 [95% confidence interval (95% CI), 0.85 to 1.55] per five-unit higher BMI). Overweight and obesity were associated with higher odds of annual percent change in TKV of ≥7% versus <5% (overweight: odds ratio, 2.04 [95% CI, 1.45 to 2.87]; obese: odds ratio, 4.31 [95% CI, 2.83 to 6.57] versus normal weight). eGFR decline did not differ according to BMI (fully adjusted difference in decline of -0.95 [95% CI, -2.32 to 0.40] ml/min per 1.73 m2 per year per five-unit higher BMI). The three-way interaction (treatment×time×BMI group) was not statistically significant in linear mixed models with an outcome of TKV (log-transformed estimated coefficient comparing the treatment effect for overweight versus normal weight: 0.56% [95% CI, -0.70% to 1.84%] per year; P=0.38; obese versus normal weight: 0.07% [95% CI, -1.47% to 1.63%] per year; P=0.93) or eGFR (estimated coefficient comparing overweight versus normal weight: -0.07 [95% CI, -0.95 to 0.82] ml/min per 1.73 m2 per year; P=0.88; obese versus normal weight: 0.22 [95% CI, -0.93 to 1.36] ml/min per 1.73 m2 per year; P=0.71). Overweight and particularly obesity are strongly and independently associated with kidney growth, but not eGFR slope, in the TEMPO 3:4 trial, and tolvaptan efficacy is irrespective of BMI categorization. Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4, NCT00428948.

PDB5 Determination of Payer Budget Impact from Using an Innovative in Vitro Diagnostic in the Management of Diabetic Kidney Disease

To evaluate the budget impact from implementing a proactive testing regime for chronic kidney disease in patients with type-2 diabetes (T2D). PromarkerD is an innovative biomarker-based blood test that predicts risk of diabetic kidney disease (DKD) and renal decline in T2D patients. This research aims to assess whether PromarkerD could reduce costs to US payers (currently $50 billion to the US healthcare system). This four-year model evaluated potential net savings to US payers from covering the PromarkerD test versus standard-of-care (SOC) in T2D patients with no/mild DKD (KDIGO categories G1-3b). Parameters were derived from prior literature and clinical studies, and included costs and frequency of testing, costs associated with changes to patient treatment strategies, and savings from slowing DKD progression and ESRD interventions (dialysis and kidney transplants). Model assumptions included testing rates (annual for low-risk, biannual for high-risk), 80% adherence to preventative medications, and a 20% decline in progression through DKD stages. Covering PromarkerD testing per million T2D patients could produce savings for US payers of $2.3 billion over four years, against costs of $1.5 billion (net savings: $846m). Savings arise from slower DKD stage progression ($1.4b), delayed dialysis and transplants ($667m), and fewer unplanned dialysis ($272m), while costs include testing ($665m), and preventative treatments in high-risk patients ($793m). Sensitivity analysis showed that if the decline in progression was set to 15%, net savings were still $353m. Changing SOC by implementing an alternative PromarkerD testing regime in T2D patients could reduce unnecessary adoption of new therapeutic interventions in low risk patients, and enable early intervention for high risk patients, thereby slowing progression and lessening the need for expensive dialysis and transplants. This study demonstrates substantial near-term savings to US payers in the treatment of DKD through early, accurate and cost-effective prognosis with the PromarkerD test.

408-P: Improving Knowledge and Confidence of Diabetologists and Endocrinologists Related to MRAs for CKD in T2D with Curriculum-Based Online Education

The goal of continuing medical education (CME) is professional growth and improved patient care. We sought to determine if a curriculum of online continuing medical education (CME) activities could improve the clinical knowledge and confidence of diabetologists and endocrinologists (D/Es) related to use of mineralocorticoid receptor antagonists (MRAs) in the management of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D). The online CME curriculum consisted of 5 online activities. Of these, 4 used repeated pairs pre-/post-assessment study design was used and McNemar’s test (P &amp;lt;.05 is considered significant) to assess educational effect. The activities launched in 2020 and data were collected for up to 12 weeks. The education reached over 19,000 physicians, including 6,000 D/Es. Overall, knowledge improved by 9% among D/Es (N=1,111, P&amp;lt;.001) Specific improvements: • 8% relative increase in knowledge related to the role of MRAs in treatment of CKD in T2D (P&amp;lt;.01) • 16% relative increase in knowledge related to the mechanism of action (MOA) of MRAs for CKD in T2D (P&amp;lt;.01) • 9% relative increase in knowledge related to identifying CKD in patients with T2D (P&amp;lt;.01) Of the D/Es who were included, 34% had a measurable increase in confidence, and among those the average level of confidence increased 50%. While this curriculum demonstrated success in educating on this topic, some gaps still remain after education. On average, 22% of the questions assessing knowledge on the MOA of MRAs in managing CKD in T2D and 29% of the questions assessing knowledge related to the role of MRAs in the management of CKD in T2D were still incorrectly answered after education, demonstrating a need for more education in these areas. Disclosure A. Larkin: None. K. L. Hanley: None. A. Le: None. Funding Bayer AG

A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure Using a Large Administrative Claims Database

BackgroundTo create an appropriate chronic kidney disease (CKD) management program, we developed a predictive model to identify patients in a large administrative claims database with CKD stages 3 or 4 who were at high risk for progression to kidney failure.MethodsThe predictive model was developed and validated utilizing a subset of patients with CKD stages 3 or 4 derived from a large Aetna claims database. The study spanned 36 months, comprised of a 12-month (2015) baseline period and a 24-month (2016–2017) prediction period. All patients were ≥18 years of age and continuously enrolled for 36 months. Multivariate logistic regression was used to develop models. Prediction model performance measures included area under the receiver operating characteristic curve (AUROC), calibration, and gain and lift charts.ResultsOf the 74,114 patients identified as having CKD stages 3 or 4 during the baseline period, 2476 (3.3%) had incident kidney failure during the prediction period. The predictive model included the effect of numerous variables, including age, gender, CKD stage, hypertension (HTN), diabetes mellitus (DM), congestive heart failure, peripheral vascular disease, anemia, hyperkalemia (HK), prospective episode risk group score, and poor adherence to renin-angiotensin-aldosterone system inhibitors. The strongest predictors of progression to kidney failure were CKD stage (4 vs 3), HTN, DM, and HK. The ROC and calibration analyses in the validation sample demonstrated good predictive accuracy (AUROC=0.844) and calibration. The top two prediction deciles identified 70.8% of patients who progressed to kidney failure during the prediction period.ConclusionThis novel predictive model had good accuracy for identifying, from a large national database, patients with CKD who were at high risk of progressing to kidney failure within 2 years. Early identification using this model could potentially lead to improved health outcomes and reduced healthcare expenditures in this at-risk population.

MO171BARRIERS TO RENAL SUPPORTIVE CARE IN SINGAPORE: A SURVEY BASED STUDY OF NEPHROLOGISTS, GERIATRICIANS AND PALLIATIVE PHYSICIANS

Abstract Background and Aims Renal supportive care is a patient-centred approach to management of advanced chronic kidney disease, especially in elderly patients. Adoption of renal supportive care in Asian countries has been slow. This study aims to investigate the barriers towards renal supportive care as perceived by physicians in Singapore. Method An online survey was sent out to all practising and training nephrologists, geriatricians and palliative physicians in Singapore public hospitals between October 1st and October 30th 2020. Responses were compiled and analysed. Results Out of 365 surveys sent, 75 nephrologists, 43 geriatricians and 28 palliative care physicians responded, accounting for a 40% response rate. Most of the participants managed 16 to 30 chronic kidney disease patients in a week. Older patients aged &amp;gt;75 years accounted for at least 30% of the chronic kidney disease cohort managed by 72% of respondents. Most agreed that renal supportive care aims to improve quality of life in chronic kidney disease (97.9%) and can be implemented alongside life-prolonging treatments such as dialysis (83.6%). However, only 51.4% recognised a distinction between renal supportive care and palliative care. Fewer nephrologists compared to geriatricians received prior palliative care training (54.7% vs 93.0%) or were certified advanced care planning facilitators (33.3% vs 67.4%). All respondents agreed that nephrologists should be aware of basic principles of palliative care, and 89.7% felt that palliative care should be incorporated into nephrology training. Most were comfortable holding discussions regarding dialysis withholding and withdrawal (93.8% and 87.7% respectively), and managing symptoms of pain (74.7%), breathlessness (87.0%) and anticipated symptoms after dialysis withdrawal (78.8%). Fewer physicians were comfortable with managing symptoms of pruritus (65.1%) and restless legs syndrome (56.2%). Majority (60%) did not feel confident in providing spiritual support as part of end-of-life care. Main barriers to renal supportive care included inadequate time during clinic consults to address the patients’ needs (87%), reliance on family members to make decisions (69.2%), inadequate palliative training during fellowship (67.1%) and inadequate community support services (55.5%). Some cited lack of awareness and acceptability of renal supportive care amongst patients and relatives in Singapore’s Asian cultural context. Most felt that encouraging advanced care planning discussions earlier in the course of chronic kidney disease (80.8%), having dedicated renal supportive care services in hospital (78.1%) and including palliative care rotation as part of training (69.2%) could potentially increase uptake of renal supportive care in Singapore. Conclusion Nephrologists, geriatricians and palliative physicians in Singapore recognise the value of renal supportive care, but are faced with barriers such as patients’ and family’s resistance toward renal supportive care as well as inadequate palliative training. A unique model of renal supportive care with the patient as well as family’s involvement early in the decision-making process is likely to be better perceived in Asian countries. Incorporation of palliative care training in the nephrology fellowship curriculum should be considered.

MO1050ACCESS TO DIALYSIS IN PUBLIC HOSPITALS FOR CHRONIC KIDNEY DISEASE PATIENTS: RESULTS FROM THE HEMODIALYSIS REGISTRY WAITING LIST AT ARISTIDE LE DANTEC HOSPITAL IN SENEGAL

Abstract Background and Aims The lethality and cost of chronic kidney disease (CKD) management are high in Senegal. The aim of this study was to evaluate the access in dialysis at Senegalese public’s hospitals. Method This was a retrospective cohort during 4 years (2014-2018) from the hemodialysis registry waiting list at Aristide Le Dantec University Hospital. This registry is composed by: a registration form (social survey and doctor's visa); a written letter addressed to hospital director and the national identity card. From this registry, telephone calls were made to collect data relating to mortality and access to dialysis. Results seven hundred fifty-one (751) files were collected. The mean age of the patients was 48.12 ± 15.28 years with a sex ratio of 1.02. The socioeconomic level was low in 85.40% (521/610) and average in 13.61% (83/610). The geographic origin was rural in 11.15%, semi-urban in 07.54% and urban in 81.31%. Ten patients (1.64%) had medical care coverage. On call, 49.70% (373/751) were died before accessing to public dialysis, 29.70% (223/751) had accessed public dialysis and 04.00% (30/751) didn’t yet need dialysis. Hundred twenty-one (16.10%) were unreachable and 0.50% (4/751) was unknown. Conclusion The lethality of CKD was high. Access to dialysis in public hospital remains problematic in Senegal despite its democratization. Additional efforts are needed for effective management of all patients at dialysis stage.