Dr Kathryn Ducharlet1,2, Professor Cecile Vigneau3,4, Professor Lawrence McMahon1,2, Professor Cecile Couchoud5
1Eastern Health Integrated Renal Services, Box Hill, Australia, 2Eastern Health Clinical School, Monash University, Box Hill, Australia, 3University of Rennes , Rennes, France, 4Cellule regionale REIN Bretagne, Centre hospitalo-universitare Pontchaillou, Rennes, France, 5Agence de la Biomedecine, Saint-Denis La Plaine, France
Biography:
Kathryn is a Nephrologist in Victoria with clinical and research interests in kidney supportive care, conservative kidney management and CKD. She is the co-chair of the Australian and New Zealand Kidney Supportive Care special interest group for the past 4 years and spent 2024 on a sabbatical in France learning about their CKD registry.
Aim:
To investigate the timing and outcomes of treatment decision-making for people with advanced chronic kidney disease (ACKD).
Background:
Treatment planning is central to ACKD care, yet decision-making data are limited.
Methods:
An observational cohort study using the French REIN Registry included adults with eGFR ≤20mL/min, no prior renal replacement therapy (RRT), and ≥1 nephrology clinical review.
Results:
From January 2020 to June 2024, 2199 patients were followed for 15.4 months (mean). Grouping was by treatment plan: management not discussed (MND) (n=316),
discussed but no decision (DND) (n=477),
conservative kidney management (CKM, n=183), dialysis/transplant (RRT) (n=1223).
RRT patients were younger 69 years (median) than CKM (86 years, p<0.05) and had longer nephrology follow-up. Cancer was most common in MND (37%) and cardiovascular disease was highest in CKM (67%, p<0.05). More CKM patients lived alone (32%) and 60% for RRT lived with family (p<0.05). No differences were observed for sex, BMI, or ACKD cause.
Older age, shorter nephrology follow-up, cancer and earlier CKD stage were associated with MND or DND in logistic regression analysis. Social, functional factors and other comorbidities were not associated with outcome.
Treatment plans changed in 10%. At study end, 398 remained as DND of which 18% started dialysis 17% died; in MND (n=286), 12% commenced dialysis 12% died, among those planned for CKM (n=237), 5% started dialysis 35% died. Across these groups, unplanned RRT was associated with higher mortality, more temporary catheter use and less transplant waitlisting.
Conclusions:
Treatment decision-making is complex and evolves over time. The lack of planning evident in certain subgroups appeared associated with poorer outcomes, highlighting the need for targeted and ongoing interventions.