HANNAH WALLACE1,2,3, QIUMIAN WANG1, KYLIE SIMONI1, DR SANDRA CRIKIS1, A/PROF CRAIG NELSON1,2,3
1Department of Nephrology, Western Health , Melbourne, Australia , 2Department of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia , 3Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia
Biography:
Dr Hannah Wallace is a nephrologist at Western Health in Melbourne. She is a PhD candidate at Melbourne University and The George Institute for Global Health, with her research focus on understanding current patterns of chronic kidney disease care and exploring models to improve care. She has a keen interest in digital health and is a honorary clinical fellow with the Centre for Digital Transformation of Health, University of Melbourne.
Aim:
To evaluate the clinical outcomes and patient satisfaction of a new nurse practitioner (NP) chronic kidney disease (CKD) clinic.
Background:
We established a new CKD NP clinic dedicated to nephrology referrals with early CKD (stage 1-3 and UACR <150mg/mmol).
Methods:
All adults seen in the CKD NP clinic from 24/10/2023 to 23/10/2024 were included. The change in kidney function, albuminuria and blood pressure, and the change in percentage of patients on guideline-recommended medications was compared from referral to discharge. Patient satisfaction was assessed using an anonymous patient survey.
Results:
There were 95 patients with a median age of 63 (IQI 51-76) and 45.3% were female. Cardiometabolic co-morbidity was common; 82.8% of patients had hypertension, 55.6% diabetes and 25.2% cardiovascular disease. At baseline median eGFR was 58ml/min/1.73m2 (IQI 42-84) with no change at discharge (60.5ml/min/1.73m2 IQI 42-84, p=0.815). Referral median UACR was 32.8mg/mmol (IQ1 12.7-55.8) which was significantly lower at discharge (12.4mg/mmol IQI 2.9-25.3, p<0.001). Systolic and diastolic blood pressure were lower at discharge (mean difference mmHg [95% CI, p value]: 10.1 [6.58-13.54, <0.001] and 5.2 [2.6-7.7, <0.001] respectively). More patient at discharge were on a RAAS inhibitor (88.4% versus 76.8%), SGLT2 inhibitor (53.6% versus 28.4%), MRA (23.1% versus 5.2%) and GLP1-RA (23.1% versus 9.6%). Three quarters of patients were discharged to their general practitioner. The survey response rate was 52%. All patients agreed/strongly agreed they were satisfied with care and had improved understanding of CKD, and 98% agreed/strongly agreed they were motivated to improve their kidney health.
Conclusion:
The CKD NP clinic had high patient satisfaction and improved the number of patients on guideline-directed care with improved albuminuria and blood pressure control.
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