Dr Rachel Frederick1,2, Prof Hilton Gock2,3,4
1Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia, 2Department of Nephrology, St Vincent’s Hospital Melbourne, Fitzroy , Australia, 3Department of General Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Australia , 4Department of Medicine, The University of Melbourne, Parkville , Australia
Biography:
Rachel is dual training in Nephrology and General Medicine. Passionate about integrating patient care and clinical research, Rachel has a particular interest in dialysis decision-making, CKD pathways, and Renal Supportive Care. Outside of medicine Rachel enjoys playing clarinet, singing in a choir and bushwalking.
Aim:
To evaluate the potential use for the “Supportive and Palliative Care Indicators Tool (SPICT)” in the pivotal decision of Chronic Dialysis Initiation (CDI) vs Supportive Care.
Background:
Decisions regarding dialysis initiation consider quality-of-life (QOL) and longevity, and can be difficult. Dialysis outcomes are influenced by age, frailty and comorbidities. Therefore, CDI in elderly, frail and multi-comorbid patients have diminishing longevity benefits, adds risks of death, and impacts QOL from both treatment and complications. The SPICT is a validated prognostication tool for the final year of life in the general population. We applied version, ‘CKD-SPICT’ to CDI patients to investigate its predictive utility.
Methods:
A single-centre retrospective study of CDI patients from January 2023 to December 2023 (n=76). The CKD-SPICT criteria was applied at dialysis commencement (+ or -) using medical records and outcomes at 6- and 12- months of hub hospital admissions, dialysis complications and death.
Results:
The mean age 61.9 ± 15.1 years, 72% male, 31.5% of patients were CKD-SPICT-positive. CKD-SPICT-positivity predicted mortality at both 6 months (16.7% vs 0%, p=0.003) and 12 months (25% vs 1.9%, p=0.002). CKD-SPICT was more specific at predicting mortality compared to other traditional risk factors including age over 80 years old (p=0.53), serum albumin <35g/L (p=0.55) and presence of Ischaemic Heart Disease (p=0.42). CKD-SPICT-positive patients had more hospital presentations at 6mth (3.1 vs 1.2, p<0.001), 12mths (6 vs 1.9, p<0.001), and a higher rate of dialysis complications (RRR 34.8, 95% CI 8.3 – 145.8).
Conclusions:
This study found high mortality, complications, and hospital admission with CKD-SPICT-positivity and better predicted mortality than currently accepted risk factors. CKD-SPICT may be a valuable tool in guiding values-based discussions regarding CDI.
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