Kidney Week

Abstract: TH-OR089

A Transitional Start Unit (TSU) Improves Home Dialysis Adoption by Incident ESKD Patients

Session Information

• Home Dialysis
  November 07, 2019 | Location: 143, Walter E. Washington Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Dialysis

• 702 Dialysis: Home Hemodialysis

Authors

• Bose, Subhasish, Lynchburg Nephrology Physicians, Lynchburg, Virginia, United States

Subhasish Bose, MD, FASN



Dr. Subhasish Bose is a consultant Nephrologist with Lynchburg Nephrology Physicians, PLLC, Lynchburg, VA. He is affiliated with multiple hospitals in the area, including University of Virginia Medical Center and Centra Lynchburg General Hospital. He is Adjunct Faculty at University of Virginia Medical Center, Charlottesville, VA and Liberty University College of Osteopathic Medicine at Lynchburg, VA. He is Medical Director at Amherst UVA dialysis unit and Davita Staunton dialysis unit in Virginia. He received his medical degree from Medical College and Hospital, Kolkata, India in 2004 and then went on to undergo post-graduate training in United Kingdom to be awarded Membership of The Royal College of Physicians (MRCP) in 2008. Thereafter, he completed his Internship and Residency training in Internal Medicine at Pennsylvania Hospital, University of Pennsylvania Health System in Philadelphia in 2011. He completed his Nephrology Fellowship at Temple University, Philadelphia, USA in 2013. Dr Bose's research interests include home dialysis modalities, glomerulonephritis, cardiovascular issues in CKD and metabolic disorders.

• Bowman, Brendan T., University of Virginia School of Medicine, Charlottesville, Virginia, United States

Brendan T. Bowman,

• McPhatter, Lesley, University of Virginia, Charlottesville, Virginia, United States

Lesley McPhatter,

• Wentworth, Danielle, University of Virginia Division of Nephrology, Charlottesville, Virginia, United States

Danielle Wentworth,

• Daniel, Carson Leigh, UVA/Lynchburg Dialysis, Lynchburg, Virginia, United States

Carson Leigh Daniel,

• Abdel-Rahman, Emaad M., University of Virginia School of Medicine, Charlottesville, Virginia, United States

Emaad M. Abdel-Rahman,

Group or Team Name

• University of Virginia Dialysis Program

Background

Pre-dialysis education remains inadequate for incident ESKD patients. This is important as the first 90 days of dialysis is a vulnerable time with a high risk of hospitalization and death. To address this problem, we designed a pilot quality improvement program, the TSU, to orient, educate and empower incident patients on key aspects of ESKD. Here, we report results through 26 months.

Methods

The TSU program provides 4-6 weeks of 1:1 dialysis education on nutrition, access, finances, modalities and transplant delivered by an interdisciplinary team following a set curriculum. Setting was two University of Virginia academic dialysis units. Only in-center incident patients were eligible for enrollment. Exclusion criteria included: prior selection of home therapy, permanent long-term care residency, hospice, unstable living arrangements or severe cognitive disability. Patients received four times weekly dialysis on M/T/Th/F using NxStage S1 machines for 3-4 hours followed by the typical “long break”. Modest prescription changes by the primary nephrologist were allowed. Primary outcome was uptake of home therapies. Secondary outcomes included: comparison of weekend interdialytic weight gain (WE-IDWG) during TSU and after TSU program for patients who remained on in-center hemodialysis (ICHD) and other relevant quality metrics.

Results

81 patients enrolled in the TSU. Participants were 52% male, 60.9% black with median age of 62. ESKD cause included 35% type 2 diabetes, 34% hypertension. After education in the TSU, 30.4% of participants chose home therapy (23% PD and 7.4% home HD). Overall prevalence of home therapy in our program is 14.3% with adoption among in-center new starts lower at 5-10%. The above result represents a significant increase in home therapy adoption. Average WE-IDWG was 32% less in the TSU (1.58 kg) versus subsequent thrice weekly ICHD (2.33 kg) (p-value < 0.01). There were no hospitalizations for volume overload during the TSU program. Antihypertensive medications were reduced 12% at the end of the TSU period.

Conclusion

A TSU education program significantly increases home therapy adoption among incident ESKD patients and reduces IDWG over the long weekend break. Larger studies are required to determine the effect on hospitalizations.