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Kidney Week

Abstract: SA-PO682

Seven Days a Week Dialysis Service to Achieve an Effective In-Center Short Daily Hemodialysis Program

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Pascoal, Pedro, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
  • Simon, Adolfo, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
  • Xavier, Kelia, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
  • Bello, Vilber, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
  • Lauar, Juliane, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
  • Pascoal, Istenio, Centro Brasiliense de Nefrologia & Dialise, Brasilia, Brazil
Background

In-center hemodialysis programs usually operate Monday through Saturday, encompassing two conventional thrice-weekly schedules: Mon-Wed-Fri or Tue-Thu-Sat. On Sundays, in the midst of the long 72-hour Fri-Mon or Sat-Tue interval, dialysis centers are regularly closed and patient care relies on emergency rooms. After setting up a 6 days a week in-center short daily hemodialysis program, we started to provide dialysis treatments also on Sundays. We have now examined the 10-year impact of the seven-day availability on patient schedule and compliance as well as on hospitalization and survival rates.

Methods

We assessed the conversion rate from 6 to 7 times a week, the prevalence of absences from hemodialysis treatments (no shows), the hospitalization rate and the actuarial survival curve of 160 private-insured patients (98M/62F; mean age at dialysis initiation 57.3±8.2 yrs, range 8-92) receiving in-center short daily hemodialysis treatments (6-7 times/week; lasting 118±18.7 min, range 90-180; ultrapure dialysate and single-use highflux dialyzer). To accommodate all patient needs, our hemodialysis schedule encircles five 2-hour duration shifts on weekdays, 3 shifts on Saturdays and 2 shifts on Sundays.

Results

From June 2007 to May 2017, 24 out 160 (15%) of our cumulative short daily hemodialysis patients extended their schedule from 6 to 7 treatments per week, 9 (6%) chose Saturdays as their regular day-off, and the remained 127 (79%) have ocasionally dialysed on Sundays to replace most of the missed treatment occurring in their original track. Over the 10-year study period, the average missed treatment rate was 1.47% or 4.5 days per patient-year and the hospitalization rate was 0.4 admissions per patient-year. In parallel, the 5-year cumulative patient survival rates were 98%, 92%, 82%, 69% and 60% at 12, 24, 36, 48 and 60 mo, respectively. Sunday dialysis additional costs have been offset by favoring low missed treatment rate and very low hospitalization rate.

Conclusion

Historically all but a few dialysis centers have provided treatments and care for patients Monday to Saturday, leading to concerns of higher mortality over weekends. To sustain a short daily hemodialysis program and to overcome its compliance and economic challenges, our dialysis center has successfully established a regular seven days a week schedule.