TIME-LIMITED TRIAL OF DIALYSIS: AN AUSTRALIAN AND NEW ZEALAND PERSPECTIVE
Dr Kirsten Hepburn1,2, Ms Ilse Berquier1, Dr Louise Purtell1,3, Dr Alice Kennard4,5, Ms Laura Austin1, Dr Katrina Kramer6, Professor Ann Bonner1,7, Dr Helen Healy1,2
1Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Herston, Australia, 3Research Development Unit, Caboolture Hospital, Caboolture, Australia, 4College of Health and Medicine, Australian National University, Canberra, Australia, 5Department of Renal Medicine, Canberra Health Services, Canberra, Australia, 6Palliative and Support Care Service, Royal Brisbane and Women’s Hospital, Herston, Australia, 7School of Nursing and Midwifery, Griffith University, Southport, Australia
Aim: To survey the experiences of nephrologists, nephrology advanced trainees and nephrology nurses with time-limited trial of dialysis (TLTD) in Australia and New Zealand.
Background: TLTD is a mutually-agreed plan of dialysis for a pre-specified time period with clear criteria to be met for dialysis to continue post trial. TLTD has been suggested as an option when there is genuine treatment equipoise.
Methods: Cross-sectional study of 5-year clinician experience of TLTD. A secure online survey was distributed by Australia and New Zealand Society of Nephrology and Renal Society of Australasia to members between 14th August and 8th October 2023.
Results: Among 38 respondents (58% nursing, 42% medical; 76% female), the most common age group was 56-65 years; the most common length of practice was 11-20 years. In the past 5 years, TLTD had been offered in 39% (n=15) of respondents’ departments. 73% (n=11) had reported limits were placed on trials, however 45% (n=5) of these indicated they had seen trials with and without limits applied. Only 47% (n=7) reported time limits had been specified. The most common limit was quality of life/symptom burden outcomes (82%, n=9). The most common characteristics of patient’s who underwent a TLTD were multiple comorbidities (87%, n=13) and advanced age (80%, n=12). Mostly TLTD resulted in transition to maintenance dialysis (60%, n=9) or death during the TLTD period (40%, n=6). 25% (4/16) of medical practitioners would never offer a TLTD.
Conclusions: Nephrology staff have variable experiences of TLTD. Considerations of age/comorbidity when offering TLTD may reflect clinician uncertainty of existing evidence in guiding dialysis decision-making. This study was limited by poor response rate. More work is required to further understand TLTD.
Biography:
Dr Kirsten Hepburn is a Nephrologist with a Clinical Diploma of Palliative Medicine and a special interest in Kidney Supportive Care. She is employed as a General Nephrologist and Kidney Supportive Care Nephrologist at the Royal Brisbane and Women’s Hosptial / Metro North Hospital and Health Service. She is currently the acting co-chair of the ANZSPM and ANZSN Kidney supportive Care Special interest Group. She is involved in Kidney Supportive Care education and has delivered Kidney Supportive Care education around Australia.