Characterising patients and clinician experiences in comprehensive conservative care for kidney failure in Northern Queensland

Abstract

Background: Comprehensive conservative care (CCC) is an emerging treatment option in kidney failure (KF), but its implementation has been restricted by a limited understanding of KF populations, outcomes and clinician experiences.

Aims: This pilot study aimed to investigate the characteristics of patients who are opting for (CCC) in North Queensland, Australia. It also aimed to highlight clinician factors impacting treatment discussions.

Methods: It was an observational study facilitated through an online cross-sectional survey to nephrologists, nephrology advanced trainees and nurse practitioners working across North Queensland.

Results: Study participants disagreed with the statement that patients commencing dialysis are more likely to have cardiac co-morbidities (46.7%), diabetes (40.0%), stroke (60.0%), liver disease (60.0%), chronic lung disease (53.3%), cognitive impairment (60.0%) and use of mobility aids (80.0%) than those commencing CCC. Conversely, they agreed that patients commencing dialysis are more likely to be independent (66.7%) and living in their private residence (40.0%). The median frailty score in patients choosing dialysis was 3.0 (interquartile range (IQR) 2.8-3.3), while that of patients selecting CCC was 4.5 (IQR 3.8-7.0). Our participants were aware of at least one clinical prognostication tool, and the one most frequently used was the 'Surprise Question' (46.2%, n = 6). Overall, our participants demonstrated low confidence (median 8.0%, IQR 6.0-8.0%) in facilitating CCC discussions.

Conclusion: Patients who are highly co-morbid and frail and have functional impairment are suitable candidates for CCC. More focus needs to be placed on objective prognostication of patients and the upskilling of clinicians to advocate for, and deliver, CCC.

Keywords: comprehensive conservative care; kidney supportive care; prognostication; treatment options.