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Abstract: TH-PO283

The 13-Year Experience of Performing In-Center Short Daily Hemodialysis - Who Pays for It?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pascoal, Mateus, Centro Brasiliense de Nefrologia & Dialise, BRASILIA, Brazil
  • Fernandes, Andre, 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

Conventional hemodialysis (CHD: 4h3x/wk) has been associated with poor quality of life and high morbidity, hospitalization and mortality rates. An ideal hemodialysis prescription requires ultrapure dialysate, single-use biocompatible membranes, on-line blood monitoring and more frequent and/or longer treatments. Hospitalization represents a significant financial burden, accounting for 40% of total dialysis expenditures. We have successfully run an in-center short daily hemodialysis program (SDHD: 2h6-7x/wk) complying with all requirements for an ideal prescription in the last 13 years. This study aims to demonstrate how we have configured dialysis delivery, improved outcomes and managed resources to achieve an optimal sustainable dialysis practice.

Methods

Operational (productive efficiency, patient compliance and payers coverage), clinical (hospitalization, kidney transplantation and survival rates) and economic (supply dialysis cost, cost-savings and net savings) landscapes were assessed in 176 consecutive unselected private-insured patients (108M/68F; mean age 57.6±19.0 yrs, range 8-97) receiving in-center SDHD treatments (6-7x/wk; lasting 117.2±8.8min, range 105-150; ultrapure dialysate and single-use high-flux dialyzer) from Jun/05 to May/18. Reimbursement has been largely based on patient outcomes and hospitalization rates.

Results

Our in-center SDHD program operates five 2-hour shifts a day (67% higher productivity without increasing fixed costs), the average missed treatment rate was 1.47% and an incremental negotiated approach reached universal insurance coverage for daily regimen. Average hospital stay (2.97 days per patient-year), kidney transplantation rate (7.5%) and mortality rate (7.3%) were better than reported for CHD hospital stay (12 days per patient-year), kidney transplantation rate (4.6%) and mortality rate (19.9%). Daily hemodialysis consumables costs doubled, adding 25% for patient overall cost. Conversely, hospital total length of stay was 75% lower, reducing overall costs by 30% and offseting the additional supply cost.

Conclusion

Our dialysis care redesign has markedly improved patient outcomes and dramatically reduced hospital stays and expenses. With clinical and economic variables combined, it has been possible to sustain a distinctive yet affordable maintenance hemodialysis program.