CKD Symptoms in Patients Receiving Kidney Supportive Care (KSC)

Background: Reducing symptoms is essential to improving quality of life in CKD. KSC can achieve this, and can be used for all treatment modalities, including conservative kidney management (CKM). However, KSC is not widely available in the US, and its impact is not well described. Methods: Patients completed the IPOS-Renal, a CKD symptom survey for which higher scores represent greater burden, at each visit to our KSC clinic between May 2016 and December 2023. Results: 189 patients were followed for a mean of 5 months (range 0-58), with a mean of 3 surveys/patient. 69 (37%) were on dialysis, 42 (23%) had chosen CKM, the remainder were deciding (26%), planning for dialysis (5%), or without advanced CKD (9%). Compared to dialysis patients, CKM patients were older (84 vs. 64 years), more likely to be White (69% vs. 39%), non-Hispanic (74% vs. 58%), and have a higher Charlson comorbidity score (10 vs. 6). Mean GFR of CKM patients was 12 mL/min/1.73m2. CKM patients had a lower initial symptom burden than dialysis patients (21 vs. 29), and this was maintained over time (Figure 1). Both groups had an initial decrease in their symptoms, however, KSC was more effective at sustaining this response in CKM. Linear mixed models assessing longitudinal change over 58 months showed that IPOS renal scores were 7.7 points higher in dialysis patients than in those on CKM (p=0.03), after adjusting for comorbidities. Conclusion: To our knowledge, this is the first US data showing that KSC appears to be an effective at reducing CKD symptoms. The benefits appear to be more sustained in patients who had chosen CKM. Additional investigation of the impact of KSC and the trajectory of CKM symptoms is warranted. Funding: NIDDK SupportFigure 1: Total IPOS-Renal score over time in people receiving kidney supportive care, Dialysis vs. Conservative Kidney Management, *significance = p<0.05