SP709STARTING DIALYSIS IN SOUTH WEST WALES: DOES INPATIENT STATUS AFFECT OUTCOME?

Abstract

Introduction and Aims: Many patients start dialysis without prior care from a renal physician or unexpectedly despite renal follow up. There is evidence that these patients have an increased risk of complications and mortality (Chiu et al., 2012). The aim of this paper was to assess the demographic information on the patient population for 2013 and to identify the number of optimal starts to dialysis in our renal department. The work also aimed to assess the difference between patients initiating dialysis as an inpatient and outpatient and how these two populations differ in terms of mode of presentation to the department and patient endpoints. Methods:We investigated the outcomes in incident dialysis patients within a regional renal centre in SouthWales. Using the electronic data base VitalData, 101 new starters to dialysis in 2013 were identified and retrospectively analysed, 3 patients had to be removed due to insufficient data. Patients who started dialysis were categorised into three different groups: Acute patients were described as those with Acute Kidney injury (AKI) or acute-on-chronic renal failure requiring urgent inpatient dialysis and remaining on dialysis for 90 days. 'Crashlanders'(CL) were patients presenting with end-stage renal failure requiring dialysis who were either; not previously known to renal services or had been referred within 3 months of requiring dialysis, and chronic; patients known to the department and under follow-up. Results: Of our cohort the majority of patients starting dialysis in 2013 were male (71%), and the mean age of new starters was 65 years. Overall 16 patients initiated dialysis via CAPD (continuous ambulatory peritoneal dialysis) and 82 began with haemodialysis. In 2013 forty-seven patients started dialysis in the most favourablemanner; chronically and as an outpatient. Fifty-one patients had a suboptimal start to dialysis meaning either they presented acutely, as a 'crashlanders' or started in an inpatient setting. In the outpatient population 14 patients began with CAPD compared to 39 on haemodialysis. Of the inpatient population 2 patients started with CAPD compared to 43 on haemodialysis.No patient altered their dialysis mode during the study period.Of the outpatient population 11% had a successful transplantation in comparison to 4% of the inpatient group. Inpatients who started dialysis acutely or as 'crashlanders' had higher mortality rates of 36% compared to 13% of the outpatient population. Conclusions: In conclusion, it is clear from this work that more needs to be done to improve optimal starts for dialysis patients. Identification of at risk patients is one way to do this. By educating both our primary care and secondary care colleagues in the recognition of patients who would benefit from early referral to a nephrologist we could identify these patients and thus improve their outcomes.We have demonstrated the continued trend that initiating dialysis as an inpatient is associated with increased mortality and additionally identified a reduction in transplant rates for these patients. Finally, our evidence suggests we must do more to educate our patients regarding their dialysis mode choices, especially in those who present acutely to our renal departments. (Table Presented).