Dr James Cohen1, Ms Linda Coventry1,2, Dr Wai Hon Lim1, Dr Ashley Irish3,4, Dr Ramyasuda Swaminathan3, Dr Harish Puttagunta3, Ms Kim Tracey4, Dr Khalil Patankar5, Dr Doris T Chan1
1Sir Charles Gairdner Hospital, Nedlands, Australia, 2Edith Cowan University, Joondalup, Australia, 3Fiona Stanley Hospital, Murdoch, Australia, 4Bunbury Hospital, Bunbury, Australia, 5Royal Perth Hospital, Perth, Australia
Biography:
Dr James Cohen is a medical registrar at Sir Charles Gairdner Hospital. Graduating with Honours in biochemistry from the University of Western Australia in 2014, and a Doctor of Medicine from Flinders University in 2019, he started Basic Physician Training at Sir Charles Gairdner Hospital in 2023. He hopes to enter Advanced Training in Nephrology in 2026.
Aim:
To explore patient-level characteristics associated with acuity in prevalent haemodialysis (HD) patients in Western Australia (WA).
Background:
A statewide cross-sectional survey in WA found that 74% of prevalent HD patients had intermediate or high acuity using the Renal Dialysis Patient Dependency Classification Instrument (RDPDC) HD acuity tool. However, patient and system level drivers of high HD acuity remain poorly understood.
Methods:
HD acuity and frailty status of 778 HD patients from WA were linked to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Univariable and multivariable multinomial logistic regression models were used to examine associations between HD acuity (standard, intermediate, high) and characteristics including age, gender, late referral status, comorbidities, smoking status, cancer history, dialysis vintage, geographical remoteness and frailty using the Clinical Frailty Score (CFS). Where data was incomplete, patients were censored from the regression models.
Results:
Among 778 HD patients, 260 (33.4%) were classified as intermediate acuity and 320 (41.1%) as high acuity. Median age was 64 years (IQR 52-76), with 23.5% late referrals, and 8.4% assessed as extremely frail (CFS>7). Extreme frailty (CFS >7) was strongly associated with high acuity, with an adjusted relative risk (RR) of 139.6 (95% CI 18.4-1058.1). Remote residence (13.8%) was also associated with high and intermediate acuity, with adjusted RRs of 2.4 (1.0-5.5) and 2.4 (1.2-4.9), respectively. No associations were observed for age, gender, late referral status, co-morbidities including diabetes, smoking status, cancer history, dialysis vintage and HD acuity.
Conclusions:
Frailty and geographic remoteness are key determinants of increased HD acuity in WA. These findings underline the need for targeted resource allocation to support vulnerable dialysis populations.
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