Introduction

Worldwide and in Singapore there is an increasing incidence of Stage 5 chronic kidney disease (CKD). Timely CKD education and appropriate planning for renal replacement therapy (RRT) can improve patient’s outcomes and reduce cost. 

Low Clearance Clinic (LCC) program was set up in our hospital as a multicomponent intervention to improve patient clinical outcome. It is hypothesized that patients managed under LCC tend to fare better. This retrospective study aims to determine if the hypothesized benefits hold true in the local population.

Methods

92 patients, age range 33-88 with CKD stage 4-5 and who were initiated on renal replacement therapy (RRT) or had pre-emptive transplants over a 2 year period were recruited. 46 patients were with LCC clinics and 46 were with usual care nephrology clinic. The two groups were matched for age and stage of CKD. Primary outcome was number of patients initiated on RRT with permanent access. Secondary outcomes included changes of biochemical markers, rate of CKD progression, number of hospitalizations.

Results

Both groups were comparable across demographics. Odds ratio of permanent access was 4 times higher in LCC as compared to non-LCC (OR = 4.51 (1.64, 12.38). Both groups do not differ in length of time from estimated glomerular filtration rate (eGFR) 20 to RRT initiation (604 vs 643 days, p = 0.761) Both groups also do not differ in their serum biochemistry levels at point of dialysis initiation (p > 0.05)

Conclusions

Our analysis showed that patients on follow up with LCC clinic had significantly higher rates of permanent access before initiation of dialysis which will then lead to lower rates of temporary access placement and their associated complications.

In summary, despite the limitations of our study, we showed that there is great potential in running LCC clinic.