None listed
Conditions
Brief summary
Chronic Kidney Disease (CKD) Stewardship aims to identify people with mid to late stage CKD, who are admitted to hospital for any reason, to improve the proportion of patients receiving optimal guideline directed management. Patients will be enrolled from 6 different public hospitals in NSW over a period of 12 months and half will receive the CKD Stewardship intervention and half will receive usual care. This study seeks to compare the proportion of patients referred to a nephrologist, receiving appropriate medications and receiving regular kidney health testing at 12 months in the intervention group compared with the usual care group.
Interventions
The intervention cohort will be exposed to a new clinical service called Chronic Kidney Disease (CKD) Stewardship. CKD-Stewardship involves identifying all patients who have stages 3b-5 CKD, who have been admitted to hospital for any reason and are not already known to a nephrologist. Patients will be identified by using the electronic medical record (eMR) to find all hospitalised patients with an estimated Glomerular Filtration Rate (eGFR) <45ml/min on admission blood tests.
These patients wi
The intervention cohort will be exposed to a new clinical service called Chronic Kidney Disease (CKD) Stewardship. CKD-Stewardship involves identifying all patients who have stages 3b-5 CKD, who have been admitted to hospital for any reason and are not already known to a nephrologist. Patients will be identified by using the electronic medical record (eMR) to find all hospitalised patients with an estimated Glomerular Filtration Rate (eGFR) <45ml/min on admission blood tests. These patients will then be seen by a Kidney Clinical Nurse Consultant (CNC) while in hospital. For most patients, this will be within the first 48-72 hours of their admission, which will be the same day that they are identified by the CKD Stewardship team. For patients with acute confusional state (also known as delerium), or are admitted to the intensive care unit (ICU), this will be after the nephrologist and CNC have both determined that the patient is well enough to receive new health information. The patient will then be provided with general information about kidney disease and advised to have follow up kidney health check with their primary care physician on discharge. This will include a written pamphlet which includes a QR code linking to Kidney Health Australia information as well as an email address which will be monitored by the CKD-Stewardship CNC. The admitting team will also be advised (electronically on the eMR) of the diagnosis and given specific recommendations regarding further urine testing and nephrology referral, following guideline recommendations from the Kidney Disease: Improving Global Outcomes (KDIGO) CKD guidelines. That is, nephrology outpatient review will be recommended for patients with an eGFR <30ml/min, or eGFR 30-44ml/min with albuminuria. Teams will be asked to perform urinalysis, specifically the urine albumin to creatinine ratio (UACR) for all patients who do not have urosepsis, urinary tract infection or another known urinary contaminant. Teams will also be asked to add the diagnosis of CKD to the patient's medical record and the discharge summary. The primary care physician will then be sent a one page letter, outlining specific guideline directed management for their specific patient's stage of kidney disease, as per the Kidney Health Australia (KHA) general practice guideline for the management of CKD which is in line with the KDIGO guideline for the management of CKD. The intervention will be delivered once per patient, per admission to one of the intervention cohort hospitals in Sydney Local Health District (Canterbury, Concord and Royal Prince Alfred) over a 12 month period March 2024 - March 2025. We will monitor adherence to the intervention by recording which patients are seen by the CKC Stewardship CNC and have the discharge letter sent to a GP. We will also audit the hospital discharge letter after the patient has been discharged, to assess whether the admitting teams have actioned any or all of the advice given including: ordering further tests, recording the diagnosis of CKD in the EMR or making recommendations or booking appointments for nephrology outpatient follow up.
Sponsors
Canterbury Hospital, Sydney Local Health District
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Any patient admitted to a public hospital under a medical, psychiatry or surgical team between March 1 2024 - March 1 2025 2. Disease status: eGFR <45ml/min on first available admission pathology.
Exclusion criteria
Participants who: 1. Are pregnant 2. Have been seen by a nephrologist as an outpatient in the previous 12 months, as documented or referred to in the electronic medical record. 3. Have been seen by a nephrologist, or will be seen by a nephrologist as an inpatient during the incident admission. 4. Have a clear acute kidney injury (any eGFR >60ml/min in the past 3 months or >90ml/min in the past 6 months, or recover to a GFR >60ml/min during the period of enrolment. 5. Are from or being discharged to a high level care residential aged care facility 6. Have advanced dementia documented in the electronic medical record at any time 7. Are admitted under, or being reviewed by a palliative care physician for any reason, or receiving treatment with palliative intent. 8. Have been deemed not clinically appropriate for the intervention by a nephrologist due to poor prognosis or very advanced and complex comorbidities which make the benefit of CKD Stewardship very unlikely 8. Have died
Outcome results
None listed