#4315 KIDNEY SUPPORTIVE CARE FOR PATIENTS ON PERITONEAL DIALYSIS: ARE SYMPTOMS BEING ADDRESSED? A RETROSPECTIVE STUDY
Authors: Brand Holly , Purtell Louise , Berquier Ilse , Bonner Ann , Kramer Katrina , Austin Laura , Healy Helen , Hepburn Kirsten 
Published: June 2023

Abstract

Background and Aims
Kidney Supportive Care (KSC) is a standard of care for patients with advanced kidney failure where health systems are responding to the high burden of experienced physical and psychosocial symptoms. While symptom burden in those receiving haemodialysis (HD) has been previously studied, there is a paucity of studies examining the symptom experience of those on peritoneal dialysis (PD). The aim of this study was to describe symptom burden experienced by patients on PD and HD seen in a KSC clinic.

Method
This retrospective cohort study analysed data of patients attending a multisite KSC clinic in Brisbane, Australia between February 2016 and October 2022. Patient demographic characteristics, dialysis modality, Charlson Comorbidity Index (CCI) scores and Integrated Palliative Care Outcome Scale Renal (IPOS-Renal) scores were extracted from clinical records. Intra-person physical symptom burden at baseline, determined by IPOS-Renal physical scores, was compared to the scores at the subsequent clinic visit where applicable. Descriptive and group analyses were performed. P values &lt; 0.05 were considered significant.

Results
Of the 232 participants, 31 were on PD and 201 were on HD. Median age was 68 years (IQR 25), 57.3% were male, and 55.2% were referred to KSC primarily for symptom management. There were no significant differences in demographic characteristics and referral reasons between groups. At baseline (entry to KSC clinic), median CCI was 9 (IQR 4) and mean total IPOS score was 16.59 $ \pm $ 8.87. The results were not significantly different between groups. The most prevalent symptoms were weakness (76%), poor mobility (74.2%), pain (60.9%), drowsiness (55.8%) and dyspnoea (54.9%), which was similar between groups. Those on PD had a significantly higher prevalence of severe and overwhelming rated diarrhoea (p = 0.01) and pruritis (p 0.03) compared to those on HD.
145 participants attended a second clinic appointment, of which 23 were on PD and 122 on HD, a median of 91 days later (IQR 106 days). Individual symptom burden was not significantly different at the second clinic appointment. However, there was a significant improvement in the subcategory of pruritis in the PD cohort by the second appointment (mean change 0.45 $ \pm \ $0.51, p = 0.02).

Conclusion
Our results show that patients on PD have a similar burden of comorbidities and symptoms to patients on HD, as well as unique symptoms to address. In addition to the five most prevalent symptoms, pruritis and diarrhoea were identified as experienced more severely by the PD cohort. Of these, pruritis was shown to improve between KSC appointments, which may suggest that the interventions commenced at the first appointment were effective. These findings also indicate the need for further bowel assessment and management for patients on PD by KSC clinicians in our health service. This KSC cohort had fewer patients on PD than HD. Further studies are needed to elicit if there is a selection bias or if there is an underappreciation for the symptom burden of this cohort, especially given PD is delivered outside of the hospital system.