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Abstract: FR-PO796

In-Hospital Hemodialysis Services Provided by Tele-Nephrologists Using the NxStage System One S

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lea, Janice P., Emory University, Atlanta, Georgia, United States
  • Masud, Tahsin, Emory University, Atlanta, Georgia, United States
  • Someren, James T., Emory University, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
  • Tannenbaum, Jerome S., Sanderling Healthcare, LLC, Nashville, Tennessee, United States
Background

Telemedicine has recently permeated into the nephrology space allowing ESRD patients in rural hospitals without access to traditional hemodialysis (HD) to receive dialysis care without transfer to larger healthcare systems. We report 5 months of experience using non-traditional dialysis machines (Nxstage System One S) in providing hemodialysis to patients remotely monitored by tele-nephrologists in rural hospitals.

Methods

A retrospective, descriptive study of patients receiving tele-nephrology consultation and chronic dialysis services between January 2018 and May 2018 in rural community hospitals across the U.S.
Consultations were requested by the on-site physicians and were performed by reviewing the patient’s hospital EMR and performing a real-time history and physical exam with audio-video technology and Littman electronic stethoscope. Tele-nephrologists ordered HD using Nxstage System One S technology and Certified Clinical HD Technicians per standard nephrology practice. Hemodialysis treatment data was captured electronically and extracted into Excel for analysis

Results

A total of 6 rural hospitals across the U.S, provided 145 HD treatments to 51 ESRD patients (25 females, 26 males; average age 64.9 ( 22-88 years) during the first 5 months of 2018. HD prescription details with average blood flow (Qb), dialysate flow (Qd), dialysate volume, duration, flow fraction, and fluid removal (UF) rates are listed in Table 1.
Average pre-systolic BP (SBP) was 134 and post- SBP -131 with low SBP- 109. For those with pre- SBP 100-130, and pre-SBP>130, 18% and 3% respectively had intradialytic drop to SBP<90.
7% of treatments utilized a 1 K bath, 44% - 2 K bath, and 48% - 3K bath. Average hours in between subsequent HD sessions was 47.

Conclusion

Hemodialysis services provided by NxStage System One S in ESRD patients in rural hospitals is effective and safe. This low dialysate volume platform is performed at similar frequencies and UF rates as traditional dialysis platforms (high dialysate volume) without high rates of hypotension.

Table 1 HD NxStage prescription
durationQbQdvolume dialysateFFUF volumeUF ml/hrUFRpre-wt
209 min.365 ml/min300 ml/min61 L82%1581 ml80310.1 ml/hr/kg85.4 kg