There are burgeoning demands of chronic kidney disease (CKD) and kidney failure including impacts on quality of life, morbidity and mortality, healthcare costs and utilisation. Together, with an ageing population, and growing burden of diabetes and hypertension, the focus on values-based healthcare has become increasingly important.
Dialysis is a significant undertaking for patients and their families. Surveys have demonstrated that up to 20% of patients who commenced dialysis, regretted their decision. Most valued quality of life and wanted detailed information about their kidney disease, alternative treatment pathways, and their prognosis.
At The Royal Melbourne Hospital, we commenced an Advanced Kidney Care Clinic that cares for three cohorts of patients:
- Patients with advanced CKD who need additional support in the management and decision making in anticipation of kidney failure
- Conservative kidney management (CKM): patients who have their kidney failure treated without dialysis or transplantation (ie without kidney replacement therapy [KRT])
- Supportive kidney care: patients established on KRT who need additional symptom management, care coordination and future planning.
The clinic provides routine nephrology care, holistic patient assessment, scaffolded education regarding CKD and treatment pathways, and utilises a shared decision-making approach for pathway selection. A person-centred values-based health care framework is incorporated by using a technology called PerEmpo (Personalising Care, Empowering People) which allows patients, together with their clinicians, to capture their values, goals and preferences. The tool then measures and tracks the impact CKD has on the patients’ ability to live according to their defined values and goals.
