Wcn26-9213 Quality of Life in Kidney Transplantation Recipients: A Single-Centre Experience From a Lower-Middle Income Country

Introduction: Conservative kidney management (CKM) has emerged as a patient-centered alternative to dialysis for elderly and frail individuals with advanced chronic kidney disease (CKD).In rural and suburban communities -where geographic barriers and limited resources accentuate the burdens of in-center dialysis for some patients -CKM may better align with patients' preferences and quality-of-life goals.Methods: We conducted a retrospective review of shared decisionmaking consultations about choice of treatment for ESKD at a Nephrology centre serving predominantly rural and suburban populations, between January 2022 and December 2023.We collected demographic and clinical data-including age, gender, Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), autonomy and living situation -and documented intervals from counseling to first CKM clinic.We tracked patient-centered outcomes: survival time; place of care and death; and utilization of home-based, palliative, and community services.Comparisons with contemporaneous dialysis patients considered differences in age, comorbidity and frailty.Comparisons with dialysis patients were made using non-parametric tests.Results: Among 208 evaluated patients, 27 (13%) opted for CKM.The median age was 88 years (IQR 86-89.5), the median CCI was 8, and the median CFS was 6 ("Moderately to Severely Frail"), reflecting a high burden of comorbidity and frailty.Most patients lived at home (81%), predominantly in rural or suburban areas, while 19% resided in nursing facilities.Sixteen CKM patients (59%) attended the dedicated CKM clinic, while others continued general nephrology follow-up.The median interval from counseling to CKM clinic visit was 3.5 months (IQR 3-4), reflecting proactive coordination of care across dispersed settings.Over follow-up, nine patients (33%) died -three before their first clinic appointment.Among those seen in the CKM program, median post-first-visit survival was 9.5 months (IQR 4.5-12.2;range 0-14.5).Deaths were attributed to acute intercurrent illnesses (44%), CKD progression (33%), or unclassified causes (22%), with two-thirds occurring in hospital and one-third under home-based palliative care.Compared to 181 dialysis patients, CKM patients were significantly older, more comorbid, and frailer (all p <0.001).Conclusion: Patients opting for CKM are typically elderly, frail, and highly comorbid.Most deaths were not directly attributable to terminal CKD but to acute intercurrent events.These findings emphasize that CKM represents a deliberate and appropriate clinical choice rather than therapeutic omission, underscoring the need for structured,