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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
  • Bowman, Brendan T., University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • McPhatter, Lesley, University of Virginia, Charlottesville, Virginia, United States
  • Wentworth, Danielle, University of Virginia Division of Nephrology, Charlottesville, Virginia, United States
  • Daniel, Carson Leigh, UVA/Lynchburg Dialysis, Lynchburg, Virginia, United States
  • Abdel-Rahman, Emaad M., University of Virginia School of Medicine, Charlottesville, Virginia, United States

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.