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Kidney Week

Abstract: SA-PO919

An Audit of Compliance with Prescribed Dialysis Hours in a Home Hemodialysis Population

Session Information

  • Dialysis: Home Hemodialysis
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Van Eps, Carolyn L., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Hawley, Carmel M., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Cho, Yeoung Jee, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia

Group or Team Name

  • Patients and Staff of Home Haemodialysis Unit Princess Alexandra Hospital, Brisbane
Background

Increased weekly hemodialysis(HD) hours(hrs) completed is associated with improved quality and quantity of life. There are no studies examining compliance with prescribed dialysis hours(PDH) in home hemodialysis(HHD) populations who are not remotely monitored.

Methods

The number of hours each HD machine has run, as displayed on machines, was recorded on 2 occasions during routine home visits to all prevalent HHD patients of Princess Alexandra Hospital. With ethics approval, patients and staff were unaware this information was being collected. The number of HDhrs completed between the 2 readings was calculated, accounting for periods of HD away from home, set up and maintenance. This was compared with PDH documented in the medical record. Nurses and Nephrologists blindly rated compliance based upon clinical acumen. Descriptive statistics were performed to analyze trends and examined for predictors of %PDH completed.

Results

54 HHD patients were included:Age:52±14years; 26% female; diabetic nephropathy:28%, duration HHD 4(2-8)years. Duration between the 2 readings was 11(7-17)weeks. %PDR dialysed:≥90%hrs: 52%, 70-89% hrs:30%, 50-69%hrs:11% and <50%hrs:7%. Average number of hrs/week performed was 16±7. 41% of patients dialysed <15hrs/week. 46% were prescribed but only 35% performed ≥18hrs/week. Compliance was accurately estimated by nurses in 48% and by nephrologists in 43% of cases. Nephrologists rated patient compliance as significantly worse than nurses. Out of 27 demographic, psychosocial, medical and laboratory parameters, only age(coefficient 0.64, 95% confidence interval (CI) 0.26-1.02, p=0.002) and diabetes mellitus (-14.8, 95% CI -26- -3.6, p=0.01) were significantly associated with compliance with PDH in multivariable regression analysis.

Conclusion

Recording the hours HD machines have run provides a useful estimate of the HDhrs completed at home. It is minimally intrusive on patient privacy, requires no special equipment and little staff time. It does not provide information on HD session frequency or duration being performed. Accuracy of clinicians’ impressions of compliance is poor and common parameters used to monitor HHD patients are poorly predictive of compliance with PDH. Rates of poor compliance with PDH in HHD patients are significant and may contribute to the lack of consistent improvement in outcomes seen in clinical trials.