Transitions of Care in Advanced Chronic Kidney Disease

Patients who suffer from advanced chronic kidney disease (CKD) are at risk of progressing to kidney failure which is associated with a shortened life span and significant disability. The transition from advanced CKD to kidney failure requiring renal replacement therapy (RRT) [dialysis, kidney transplantation or conservative therapy] is a high-risk period that is associated with a very sharp rise in death rates in the first 6-12 months after dialysis initiation. The optimal transition of care from advanced CKD to RRT is unknown. Huge uncertainty exists on what the optimal transition pathways should be for individual patients. The University of Limerick (UL) with national and international academic partners, state agencies, and representative patient groups, propose to map transition pathways to RRT.

We believe that the excess deaths incurred by patients during transition to dialysis and continue into the first year of dialysis, are in part due to the health of patients approaching kidney failure. We also believe that the quality of care that patients receive prior to starting RRT and during the transition period is an important contributory factor.

Our goal is to improve our understanding of transitioning to RRT by creating a large registry of patients who develop kidney failure and follow their transition from advanced CKD to RRT in the Irish Health System. Using the Kidney Disease Clinical Patient Management System (KDCPMS) merged with data from the National Kidney Disease Surveillance System, we propose to better understand these transitions of care. By examining patient-level factors and center-based quality of care that patients receive prior to RRT, we hope to provide new insights into the journey from advanced CKD to RRT, and identify the optimal transition pathways. Our results are likely to inform future health policy in the management of advanced CKD and shape and re-design health service delivery.

Award Date
27 June 2019
Award Value
Principal Investigator
Professor Austin Stack
Host Institution
University of Limerick
Investigator Led Projects