Dr Simon O Connnor1, Dr Katherine Richards1
1Central and Northern Adelaide Renal and transplantation Services, Adelaide, Australia
Aim: To examine patient and unit factors resulting in unplanned dialysis starts, to determine factors that could be altered to improve patient outcomes
Background: Commencing dialysis as an inpatient has been demonstrated to have negative impacts on patients both psychologically and physically. The available literature suggests that unplanned dialysis starts occur in 40-60% of patients, and that increased age, increased comorbidity burden and cardiovascular disease are the most common associations with unplanned dialysis initiation.
Methods: We undertook a retrospective cohort analysis of all new dialysis starts in our unit from January 1 2017- December 31st 2019. We used our inpatient database compared with ANZDATA registry information to examine the differences between patients who commenced dialysis as inpatients vs outpatients.
Results: 310 new patients commenced dialysis between 2017-2020. 171 (58%) of new start dialysis patients commenced dialysis as inpatients. Median length of stay was 8 days. 111 (64%) inpatients were Male.128 (76%) of inpatients commenced dialysis with a tunelled or temporary line compared with 30 (21%) of outpatient starts. 27 (70%) of ATSI patients started as inpatients. Fluid overload was the most common reason for admission at 58(33.3%). Diabetes and IHD were commonly associated with inpatient starts. We also compared SEIFA indices of patients to show socio-economic factors that impact unplaned starts. Median SEIFA index for inpatients was 932 compared with 956 for outpatients.
Conclusions: Our study is a unique look at patient and unit factors on unplanned dialysis starts. Careful identification of risks will help us highlight areas our unit can target to reduce our rate of inpatient dialysis starts. This study has resulted in the creation of the dialysis transition group in our unit.
Biography:
Nephrology Fellow in Royal Adelaide Hospital