Renal supportive care programs: An observational study assessing impact on hospitalization and survival outcomes.

Autor: Chia XX; Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Johnston R; Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Aggarwal R; Palliative Care Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.; Department of Medicine, University of New South Wales, Sydney, Australia.; Clinical Affiliate, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia., Huynh T; Palliative Care Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.; Department of Medicine, University of New South Wales, Sydney, Australia.; Clinical Affiliate, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia., Notaras S; Department of Medicine, Western Sydney University, Sydney, Australia.; Dietetics Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Zekanovic D; Social Work Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Gordon K; Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Sasongko V; Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia., Makris A; Renal Department, Liverpool Hospital, South-Western Sydney Local Health District, Sydney, NSW, Australia.; Department of Medicine, University of New South Wales, Sydney, Australia.; Department of Medicine, Western Sydney University, Sydney, Australia.
Jazyk: angličtina
Zdroj: Nephrology (Carlton, Vic.) [Nephrology (Carlton)] 2021 Jun; Vol. 26 (6), pp. 522-529. Date of Electronic Publication: 2021 Mar 09.
DOI: 10.1111/nep.13869
Abstrakt: Aim: Renal supportive care (RSC) programs are used to manage non-dialysis end-stage kidney disease (ESKD) patients. The aim of this study was to analyse the impact of RSC programs on hospitalization and survival outcomes in these patients.
Methods: A retrospective, single-centre observational cohort study of non-dialysis ESKD patients was undertaken. Hospitalizations and survival from eGFR≤15 ml/min was compared between patients managed in an RSC program (RSC group) and patients receiving standard conservative therapy (non-RSC group). Local databases, physician letters and electronic medical records were used for data collection. Prevalent patients from 2013 to 2017 with eGFR ≤15 ml/min were included. Cox proportion hazard testing and generalized linear modelling was undertaken to adjust for confounders.
Results: A total of 172 patients were included (95 RSC; 75 non-RSC). The median age was 82 years [IQR 78-85], 46% were male, the median Charlson-comorbidity Index was 5 [IQR 4-7]. The RSC group had significantly lowered haemoglobin level (102 g/L vs. 111 g/L) and fewer English-speakers (34% vs. 44%). RSC was associated with the decreased number of days in hospital per year (estimated means 46.6 days [95% CI 21-67] vs. 83.2 days [95%CI 60.5-105.8]; p = .01) and decreased number of hospital admissions per year (estimated means 5.4 [95%CI 2.1-8.8] vs. 12.3 [95%CI 8.2-16.4]; p = .01) compared with non-RSC. Median overall survival from eGFR≤15 in the entire cohort was 735 days, with no significant difference between RSC and non-RSC groups (p = .9), both unadjusted and adjusted for confounders.
Conclusion: RSC programs can significantly decrease the number and length of hospitalizations in conservatively managed ESKD patients.
(© 2021 Asian Pacific Society of Nephrology.)
Databáze: MEDLINE
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