Kidney supportive care (KSC): Evaluating need in a time of crisis

Abstract

Aim: To evaluate how the COVID‐19 pandemic affected kidney supportive care (KSC) referrals and care.

Background: Our health service re‐designed delivery of the KSC service in response to COVID‐19, including transitioning to a telehealth model and prioritising advance care planning (ACP).

Methods: Activity was audited over two three‐month periods between 1 October‐31 December 2019 (PRE‐COVID‐19) and 11 March‐11 June 2020 (POST‐COVID‐19). Baseline demographics (age, gender), severity of kidney disease (eGFR, kidney replacement therapy [KRT]), patient functionality (resource utilization groups [RUG], Australian Karnofsky performance score [AKPS]), and reason for referral (advance care planning [ACP], decision making, symptom management, conservative management) were extracted from clinical records. Statistical analysis was performed in SPSS and included Chi square, independent T and Mann‐Whitney U tests as appropriate.

Results: Pre‐COVID‐19 there were 29 referrals, with median age 73 (IQR = 17), eGFR 13 (IQR = 7), 27.6% receiving KRT, mean RUG 5.76 (SD = 2.3) and AKPS 56.52 (SD = 12.03). There were 54 POST‐COVID‐19 referrals, median age 75 (IQR = 12.75), eGFR 14 (IQR = 8.75), 35.19% KRT, mean RUG 5.22 (SD = 2.7) and AKPS 60 (SD = 13.2). 92 patients were seen pre‐COVID‐19 and 135 POST‐COVID‐19. PRE vs POST‐COVID‐19 results showed that 44.8% vs 63% (p = 0.175) were referred for ACP, 13.8% vs 5.6% for decision making (p = 0.382), 31% vs 18.5% for symptom management (p = 0.308). Conservative management was indicated as the reason for referral, more frequently, pre‐COVID compared to post‐COVID (69% vs 29.6%, p = 0.001).

Conclusions: Meeting the needs of this vulnerable group of patients was a priority of the health service as evident in the increased activity through the clinic. The types of activities shifted, with a focus on ACP via a telehealth model, without a significant change in the characteristics of patients.