A PROGNOSTIC TOOL TO ASSIST THE DECISION OF CHRONIC DIALYSIS VS BEST SUPPORTIVE CARE – JUST BECAUSE YOU CAN DOESN’T MEAN YOU SHOULD
Dr Rachel Frederick1, A/Prof HILTON GOCK1,2,3
1Department of Nephrology, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Department of General Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 3The University of Melbourne, Parkville, Australia
Aim: We investigated a simple prognostic tool, the Supportive and Palliative Care Indicators Tool (SPICT) that may assist decision making on initiating Chronic Dialysis vs Best Supportive care.
Background: Advancing age, frailty and comorbidities negatively impact on dialysis outcomes. There is increasing concern that the burden and complications of dialysis may harm both quality of life and longevity in patients with limited life-expectancy. The Supportive and Palliative Care Indicators Tool (SPICT) has been validated for prognostication for the final year of life. We applied the tool retrospectively on patients commencing dialysis and analysed outcomes to investigate its potential in assisting the decision of dialysis initiation.
Methods: A single-centre retrospective cohort study of consecutive dialysis patients from two periods January-February 2023 & August-September 2023 studying outcomes at 6 months and 12 months following dialysis initiation. Demographics, SPICT criteria at commencement of dialysis, and outcome measures including tertiary hospital admissions, dialysis complications and mortality to date.
Results: There was a total of 23 patients. Mean age was 67.5 +/- 12.3 years, 83% male, 52% of patients were SPICT positive. SPICT positive patients had more hospital presentations at both 6-month (2.4 vs 1.1, p=0.024) and 12-month groups (5.6 vs 1.7, p=0.0005). SPICT positivity was associated with dialysis complications with a relative risk-ratio of 14.4 (95% CI 1.4 – 150.8). All deaths (n=2) were SPICT positive giving a 20% annual mortality.
Conclusions: This pilot study found high mortality, complications, and hospital admission with SPICT positivity. The SPICT tool prognostication may assist with patient selection and shared decision making regarding chronic dialysis vs supportive care in end-stage renal failure.
Presentation Slides PDF – Click here
Biography:
Rachel is an Advanced Trainee in Nephrology and General Medicine, enjoying the challenge of a diagnostic dilemma and an interest in General Nephrology. She is currently a member of ANZSN Education and Training Committee.