447Q - Research Paper

Abstract
Aim:
To provide a structured framework for detecting and managing CKD that will improve the coding of CKD diagnosis in primary care practices. 

Method:
In 2023, we undertook a clinical audit program in primary care across Australia. The program introduced a framework to evaluate CKD data and identify improvements for systems. Practices undertook data collection and analysis, CKD education, practice team meetings, and review of associated practice systems. Participants reviewed their practice data 3 times across a 6-month period. Data gaps in CKD diagnosis were highlighted, benchmarked against local data and end point data. The findings were discussed and benchmarked against the other participating practices (anonymously). Participants were given lists of people to review over the 6-month period. Whole of practice quality improvement plans were discussed and implemented to address the CKD diagnosis gaps. 

Results:
Across the program 958 new patients were identified as having CKD, this represents an increase in coded diagnosis of 124%.  Other results indicate that practice systems such as recall protocols were improved, knowledge and understanding of CKD improved by 60% driving behaviour change in primary care. 

Conclusion:
Implementing a formal framework for detection and managing CKD using practice data leads to improvements in coded CKD diagnosis, health practitioner knowledge and understanding of CKD and improved practice systems.

448C - Research Paper

Abstract
Case Description:
There have been unprecedented advances in the recommendations and care for people with CKD over the last 18 months with the PBS listing of new medications and release of new guidelines. This presentation will highlight key information from the new handbook, provide an overview of what has changed in CKD detection and management, and discuss new data in the context of practice implications for renal nurses. We will provide practical examples of ways in which renal nurses can engage with their local primary care practices to provide education on the new recommendations, get involved in CKD initiatives, support patients and foster a link between care delivered in the community and that delivered in the renal unit. 

Discussion:
Nurses will gain and understanding of the new recommendations for detecting and managing CKD and how they can support the implementation of these in their local area.We will provide nurses with practical tools, resources and education that can be assist them to build connections with primary care practices.

Conclusion:
Renal Nurses are well positioned to support the implementation of the new guidelines in practice and have the opportunity to positively impact on patient outcomes.

435R - Research Paper

Abstract
Aim:
This study employs a drug-target Mendelian randomisation (MR) approach1 in the general population to investigate the effect of cardiometabolic drugs for improving kidney function.

Method:
We identified single nucleotide polymorphisms as proxies for anti-hypertensive (Ca-channel blockers, beta-blockers, ACE inhibitors); anti-diabetic (SGLT2-inhibitors, metformin); and cholesterol-lowering (evolo-/alirocumab, statins, and ezetimibe) drug targets. Their intermediate effects on systolic blood pressure, HbA1c, and low-density lipoprotein (LDL) cholesterol level were used as exposures, while the outcome was annual decline of creatinine-based estimated glomerular filtration rate (eGFR) in 343339 individuals (74% European ancestry)2. We implemented several two-sample MR methods (inverse variance weighted, weighted median, weighted mode, MR-Egger).

Results:
A one standard deviation (SD) unit reduction in HbA1c (6.75 mmol/mol) via SGLT2 (target of SGLT2-inhibitors) caused an improvement in annual eGFR by ϐ=0.40 (95%CI 0.22; 0.59). A one SD reduction in LDL cholesterol (38.7 mg/dL) via PCSK9 (target of evolo-/alirocumab) decreased annual eGFR by ϐ=-0.07 (95%CI -0.13; -0.02). Inference for antihypertensive drug targets was inconclusive.

Conclusion:
Our study underscores the potential of SGLT2-inhibitors in preserving kidney function. The effect of decreasing eGFR was specific to evolo-/alirocumab but not the other cholesterol-lowering drugs. The results support personalized treatment for cardiometabolic patients at risk of kidney impairment. Further studies are required to validate results in CKD cases. 1   Burgess, et.al. https://doi.org/10.1016/j.ajhg.2022.12.0172  Gorski, et.al. https://doi.org/10.1016/j.kint.2022.05.021

266Q - Research Paper

Abstract
Aim:
To implement a Nurse Navigator: Nurse Practitioner (NN:NP) led project to improve management of CKD at West Moreton Health Service (WMHS). The aim is to early review, risk factor management and intervention to slow disease progression through comprehensive assessment, education, lifestyle modifications, and supporting self-management.

Method:
NN: NP conceptual framework was developed and implemented as a practice guide to provide quality care for CKD patients either by face to face or through telehealth.  Practitioners visited rural hospitals to scope, understand challenges and develop partnerships prior to commencement. Establishment of telenephrology clusters, according to patient’s demographic area to provide care closer to their homes. Commencement of NP led clinics to target “early CKD” patients. Navigation of patients with complex needs referred from inpatients, dialysis unit, outpatients, community, and other health services.  Quantitative data was collected and analysed to measure the effectiveness of the project. Data is retrieved from databases such as WMHS Datahub, Nurse Navigator COMPASS, smart referrals and ieMR.

Results:
A total of 147 (NN), 128 (NP clinic) and 111 (telenephrology) patients were seen since 2019 through to Jan 2024.  This includes 856 encounters as NN, (348 face to face and 508 phone calls) 352 as NP (F2F) and 491 at telenephrology clinics. Failed to attend rates have improved with 7.2% at telenephrology and 18.4% at NP clinics. Significant reduction noted in CKD waiting list, from 459 in 2021 to 93 in Jan 2024 despite the CKD population growth. Other benefits included less travel time and costs for patients and families, care closer home, better clinic attendance rate and improved health outcomes. 26 patients were discharged back to GPs for ongoing management as their risk factors had improved.

Conclusion:
The Role on NN:NP has improved patient outcomes for CKD patients and facilitated system improvement within the WMHHS.  

513Q - Research Paper

Abstract
Aim:
Early interventions in Chronic Kidney Disease (CKD) have demonstrated notable improvements in health outcomes. Despite these advances, widespread disparities persist in accessing nephrology care. Nurse practitioners have emerged as pivotal contributors to enhancing care accessibility. However, uncertainties persist regarding the quality and outcomes of nurse practitioner-led care for CKD. This study focuses on the role of nurse practitioners in Aboriginal Community Controlled Health Services (ACCHS) and their potential to support CKD patients.

Method:
In 2023, a CKD Nurse Practitioner-led model of care was implemented, marking a significant stride towards addressing existing gaps. This quality improvement activity conducts a comprehensive review of the initial 12 months of service provision, encompassing the collection of de-identified and aggregated baseline data on client demographics and clinical profiles, including crucial kidney health measures such as pathology ordered (n-urine ACR, rental function), prescriptions (ACEI/ArB, flozins), referrals to nephrologists and Improvements in ACR, HbA1c, BP.

Results:
The Renal Specialised Nurse Practitioner model of care, particularly within the ACCHS, has proven instrumental in optimising the utilisation of limited specialist resources. There was increase and improvements in pathology ordered (n-urine ACR, rental function), prescriptions (ACEI/ArB, flozins), referrals to nephrologists and Improvements in ACR, HbA1c, BP. This strategic deployment enables nephrologists to allocate more time to patients with complex or advanced CKD, thereby leveraging their expertise. Concurrently, nurse practitioners extend their care to patients in the early stages of CKD, surpassing the capabilities of primary care providers alone.

Conclusion:
This innovative model reveals that Renal Specialised Nurse Practitioners embody an untapped potential, uniquely positioned to administer optimal Indigenous-specialised CKD management programs in rural and remote communities. Their multifaceted role includes seamless integration with primary care, comprehensive case management with intensive follow-up, adept medication management, addressing social barriers to adherence, and delivering culturally safe and appropriate healthcare.

488Q - Research Paper

Abstract
Aim:
To raise awareness about” Amazing Kidneys" highlights that diabetes and hypertension are key risk factors for CKD. encourage systemic screening of all patients/visitors/whanau in hospital population with diabetes, hypertension, urinalysis, eGFR and specialist consultation. 

Method:
Quantitative method adopted during data collection, Number of visitors, age group, sex, Ethnic background, past and current medical history 

Results:
People from various ethnic background like European, India, Chinese, Pacific islanders and Maori screened for their kidney health. 65% of the visitors were female and 35% were the male. 23% of the visitors those who got their screening done were diabetic, 34% of them had hypertension and 11% of the visitors were with both diabetes and hypertension. 8% of the total visitors consulted with kidney specialist.   

Conclusion:
Renal Services is committed to provide Education, early Detection, Screening & awareness of CKD. Events like kidney health awareness day can make a huge difference for those who are sitting on early stage of kidney disease.