Characteristics of Patients Involved With the Kidney Supportive Care Program: A Cohort Study of Routinely Collected Data

Rationale & Objective People with kidney failure face significantly higher risk of death and symptom burden. We sought insights into the survival and symptom burden of people receiving medical management of kidney failure without dialysis. Study Design Retrospective cohort study. Setting & Participants People with an estimated glomerular filtration rate (eGFR) ≤15mL/min/1.72m 2 receiving non-dialytic / conservative / palliative management, and known to the Kidney Supportive Care Team in a tertiary care hospital. Predictors EGFR at cohort entry, living arrangement, and history of ischemic heart disease, heart failure, or stroke, according to routine care databases. Outcomes Primary: median survival. Secondary: number of hospitalizations, and symptom burden assessed through the Integrated Patient Outcome Scale-Renal score. Analytical Approach Cox regression survival modeling , and descriptive statistics for hospitalizations and symptom burden. Results The cohort included 223 people receiving care between January 2016 and April 2023, with median age 84 years (interquartile range [IQR]:77-87). Median survival was 452 days (95% confidence interval [CI]:351-552). People with eGFR 11-15mL/min/1.73m 2 at cohort entry had median survival of 517 days (95%CI:406-623), those with eGFR 6-10mL/min/1.73m 2 had median survival of 260 days (95%CI:138-382) while people with eGFR <5mL/min/1.73m 2 had median survival of 61 days (95%CI:46-107). People living independently at home had significantly higher median survival (538 days), compared to assisted living at home (356 days) or living in a nursing home (232 days)(p<0.05). The studied comorbidities were not predictive of survival. At year one, the most prevalent symptom was weakness (60%) with median "moderate" severity, with similar findings at year two. Limitations Single-center, retrospective study with univariable analysis. Conclusions The study provided valuable insights into life expectancy and symptom burden with kidney failure managed without dialysis, including the prognostic value of considering baseline living situation in anticipating survival, to help guide clinicians facing the uncertainty of this clinical scenario.