Abstract: FR-PO478
Clinical and Operational Results of In-Center Nocturnal Hemodialysis (INHD) Programs in a Large Dialysis Organization (LDO)
Session Information
- Hemodialysis and Frequent Dialysis - IV
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
- Muir, Sean, DaVita Inc, Denver, Colorado, United States
- Mecum, Lillian, DaVita Inc, Denver, Colorado, United States
- Bowlby, Brooke, DaVita Inc, Denver, Colorado, United States
- Van hout, Bram, DaVita Inc, Denver, Colorado, United States
- Peterson, Zachariah W., DaVita Inc, Denver, Colorado, United States
Background
INHD offers a combination of efficacy, safety, and improved treatment tolerability. Recognizing the specific clinical and laboratory results that indicate INHD might be beneficial for a given patient requires an understanding of modality-specific therapeutic differences. Here, we report the operational characteristics and clinical laboratory results of INHD programs in an LDO.
Methods
All patients admitted to LDO INHD programs during 2017 and 2018 were included in the analysis. Patient demographic information, dialysis prescription data, laboratory markers, blood pressure, target weight, and hospitalization rates were assessed and compared to those for in-center hemodialysis (ICHD) patients treated at the LDO during the same period.
Results
Data from 2747 patients treated in 176 INHD programs were assessed. Across the LDO, 19 INHD programs started operation during 2018, 24 closed; the most common closure reasons were transition of patients to the working shift (82%) and staffing constraints (9%). Mean INHD program census was <10 patients, mean operating time was 8.9 hours/shift, and staff retention rate was 83%. Mean age of INHD patients was 52 years; 29.5% were female; access use was 68.9% AVF, 15.1% AVG, 10.6% CVC, and 5.4% other. Laboratory and clinical parameters for INHD vs ICHD patients are shown.
Conclusion
INHD was associated with improved solute clearance, lower ultrafiltration (UF) rates, improved nutritional parameters, and lower hospitalization rates compared to ICHD. Patients receiving standard ICHD who are not achieving risk factor control, are experiencing increased organ stunning risk with elevated UF rates, or with hemodynamic instability should be considered for transition to INHD.
| INHD n=2747 | ICHD n=268,572 | |
| Kt/V > 1.2 | 98.8% | 97.1% |
| Albumin > 3.5 g/dL | 85.4% | 71.4% |
| Albumin > 4 g/dL | 33.3% | 19.0% |
| Phosphorus < 5.5 mg/dL | 58.1% | 58.9% |
| Calcium ≤ 10.2 mg/dL | 97.2% | 97.4% |
| URR ≥ 65% | 94.4% | 91.3% |
| PTH 150-600 pg/mL | 53.3% | 61.0% |
| BP pre-dialysis (mm Hg) | 146.0 | 147.4 |
| BP post-dialysis (mm Hg) | 132.9 | 137.4 |
| UFR (mL/kg/hr) | 5.3 | 7.2 |
| Hospitalization rate (admissions per patient per year) | 1.40 | 1.82 |
Funding
- Commercial Support –