AUDIT OF ONCONEPHROLOGY CONSULTATIONS AT A TERTIARY CARE CENTER: A CASE FOR STARTING A DEDICATED ONCONEPHROLOGY SERVICE.

 

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https://storage.unitedwebnetwork.com/files/1099/780a557b29fb84386e04e1e97e3048ae.pdf
AUDIT OF ONCONEPHROLOGY CONSULTATIONS AT A TERTIARY CARE CENTER: A CASE FOR STARTING A DEDICATED ONCONEPHROLOGY SERVICE.

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Bhagyalaxmi
Paramshetti
Bhagyalaxmi Paramshetti bhagyalaxmiparamshetti@gmail.com Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India *
Ravindra Attur Prabhu ravindra.prabhu@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Shankar Prasad Nagaraju shankar.prasad@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Dharshan Rangaswamy dharshan.r@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Indu Rao indu.rao@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Srinivas Shenoy shenoy.srinivas@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Mohan V B mohan.vb@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Nephrology Manipal India -
Sharada M sharada.m@manipal.edu Kasturba Medical College, Manipal, Manipal Academy of Higher Education Oncology Manipal India -
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There is a high and rising incidence of kidney disease in cancer patients both due to the disease itself and because of cancer therapies. This can take the form of acute kidney injury, cancer in chronic kidney disease, dyselectrolytemias and acid base imbalances which could impact delivery of therapy and outcomes. A dedicated Onco-nephrology service resulting from collaboration between the two departments may aid in early diagnosis, safer therapy which would help recovery and survival. We did a retrospective audit of consultations from the oncology departments to make a case for initiating an Onco-nephrology specialist service at our hospital. The aim of the study is to evaluate the number and reasons for Onco-nephrology consultations and examine the results of these in a tertiary care setting. Secondary objectives are to identify the main reasons for nephrology consultations in oncology patients and to assess kidney outcomes.

After institutional ethics committee approval we did a retrospective case record based study at a tertiary care center over a period of 1 year. Patients with a confirmed cancer diagnosis referred to nephrology were included. Patient demographics, type of cancer, reason and timing of nephrology referral, interventions provided, and outcomes such as kidney recovery, treatment changes, or Hemodialysis offered. Data were summarized using descriptive statistics to evaluate referral patterns and clinical outcomes.

A total of 100 nephrology referrals were analyzed. The most common reason for referrals was acute kidney injury (AKI), which made up 55(55%) of the cases. Referral for procedures like Central venous catheter insertion for stem cell collection accounted for 19(19%). Chronic kidney disease represented 7(7%), followed by electrolyte imbalances at 6(6%) and Consults to avoid/prevent progression of AKI due to nephrotoxic chemotherapy in 3(3%). Less common reasons included urinary tract infections, treatment optimization, proteinuria, and renal biopsy for Rapidly progressive Renal Failure. This range of reasons shows the crucial role of nephrology in managing kidney problems and pre-treatment evaluations for cancer patients. Among the 100 nephrology referrals analyzed, most patients 58(58%) received conservative management. This included close monitoring, supportive care, and medical treatment without invasive procedures. Hemodialysis was needed in 21(21%) of cases, mainly due to severe kidney issues like acute kidney injury or nephrotoxicity from cancer therapy. Outcome assessed Among the 100 nephrology referrals, varied greatly. About half of the patients showed clinical improvement and were either discharged or continued with follow-up care. A significant number of patients died (20%) despite treatment. A smaller group left against medical advice (DAMA), which reflects the challenges of treatment.

Nephrology referral was useful in diagnosis and management of AKI, providing dialysis therapy, prevention of kidney injury and managing cancers in CKD patients. Starting a dedicated Onco-nephrology service would be useful.

Kewords