#361 A southeast London primary care allied health professional led point-of-care kidney clinic to pharmacologically optimise people with chronic kidney disease (protect kidney)

Abstract Background and Aims A new generation of treatments for chronic kidney disease (CKD) have potential to significantly improve cardiovascular and renal outcomes. However, barriers to implementation include renal function monitoring after renin-angiotensin-aldosterone-system inhibitors (RAASi) initiation and dose changes as well as lack of resources in primary care. This study aims to co-develop and evaluate the feasibility and acceptability of a pilot protocolled point-of-care (POC) kidney clinic, for RAASi and sodium-glucose-cotransporter-2 inhibitors (SGLT2i) optimisation in primary care. Method This quality improvement project (QIP), was conducted in three South London GP practices, co-developed with patient and public involvement and Clinical Effectiveness Southeast London. A red-amber-green (RAG) protocol guiding rapid RAASi up-titration was developed based on local and national guidelines. POC potassium and creatinine RAG thresholds were validated against the reference laboratory. Inclusion criteria: (1) adults; (2) eGFR 30–75 mL/min/1.73 m2 ; (3) urine albumin:creatinine ratio (uACR) ≥3 (if diabetic) or ≥22.6 mg/mmol (non-diabetic). Exclusion criteria: (1) RAASi/SGLT2i contra-indication; (2) baseline potassium >5.0 mmol/L; (3) taking insulin (4) eGFR <30 mL/min/1.73 m2; (5) patients under nephrology services. Blood pressure and blood (capillary or venous) tests were performed in each clinic visit and analysed using the POC Epoc Blood Analysis System (Siemens Healthineers). Medication adjustments were based on RAG protocol outcomes. Primary outcome was recruitment number. Secondary outcomes were patients who were pharmacologically optimised (maximum tolerated RAASi with SGLT2i), completed the pathway and numbers who did not attend (DNA); POC test success rates, adverse events, medication dose changes and change over time in blood pressure, creatinine, eGFR and potassium were also recorded. Patient acceptability was assessed using the Likert Scale for an adapted validated questionnaire (PSQ-18). Results After exclusions, 25/48 (52.1%) suitably identified patients agreed to participate (Fig. 1). Mean age was 64.5 ± 9.3 years and 17 were male (68%). Baseline characteristics are summarised in Table 1. There were 8 (14.8%) DNA's from 54 clinic appointments; mean duration between appointments were 25 ± 19 days; 23/25 (92%) patients completed the pathway; 20/25 (80%) were optimised. Thirty-nine (85%) protocol outcomes were green, 7 (15%) amber and none red, resulting in 40 medication changes (RAASi = 20; SGLT2i = 20). Following RAASi uptitration, there were small increases in renal biochemistry between visits (eGFR 2.82 ± 11.16 mL/min/1.73 m2; potassium 0.04 ± 0.29 mmol/L). The majority of the samples were capillary (43/44; 97.7%). POC tests were successful from 44/57 (77.2%) attempts. One patient developed visible haematuria after starting SGLT2i. There were no major adverse events. Overall, 92% (12/13) questionnaire respondents were ‘very satisfied’ with their clinic experience and 77% (10/13) were ‘very comfortable’ with finger-prick testing. The majority indicated they would prefer an advanced nurse practitioner (n = 10) or pharmacist (n = 9) for future pathways. Conclusion Patient recruitment numbers were modest, suggesting larger scale (e.g. primary care network) or wider screening of unidentified CKD would be required. The POC testing was successful (77.2%) with most patients becoming optimised and reporting a positive experience. Scale up of the clinic (across Southeast London) with a health economic evaluation is underway to assess cost effectiveness and long-term sustainability.