KIDNEY SUPPORTIVE CARE – WHERE AND WHEN ARE OUR PATIENTS DYING?
Dr Lee Skeat1,2, MS Hennessey Sharonne1
1Royal Hobart Hospital, Hobart, Australia, 2University of Tasmania, Hobart, Australia
Aim: To understand trends in renal supportive care (RSC) in Southern Tasmania including service growth, modality at death and location at death for patients.
Background: RSC continues to evolve as a subset of nephrology. RSC practices vary across services, reflecting clinician practices as well as variation in patient cohorts. Understanding local data is key in delivering a high standard of care and for expansion of renal supportive care services.
Methods: A retrospective review was undertaken of patients referred to the RSC service between 2018-2023 in Southern Tasmania. Data was analysed for trends in referrals, patient modality at time of death, age at death and patient location at death.
Results: The analysis included 245 patients. Between 2018 and 2023, new referrals increased by 600%. The majority of deaths occurred on a conservative care pathway (65%), followed by dialysis withdrawal (21%) and sudden death without withdrawal from in-centre haemodialysis (7%). There was an overall trend towards earlier RSC referrals, with average days from initial referral to death increasing across all modalities. Patient aged 80-89 years represented the majority of deaths (43%) and of those deaths, 64% were on a conservative care pathway. The minority of patients died at their preferred location with some improvement over the 5-year period (33% and 39% in 2018 and 2023 respectively).
Conclusion: There is a growing trend towards earlier referral and a higher volume of RSC referrals in Southern Tasmania. This is reflected across all renal replacement therapies & conservative care modalities and may reflect the increasing age and frailty of the local population. Expansion and further development of RSC is required to care for these patients.
Biography:
Lee Skeat is a nephrologist based in Hobart with an interest in renal supportive care development in Tasmania.