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Abstract: TH-PO199

Electronic Health Record-Based E-Alerts for Ultrafiltration Rate in Prevalent Dialysis Patients: A Quality Improvement Project

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kumar, Rajesh B., Apex Kidney Care, Mumbai, India
  • Jasani, Rachana H., Apex Kidney Care, Mumbai, India
  • Billa, Viswanath, Bombay Hospital, Mumbai, India
  • Bichu, Shrirang, Bombay Hospital, Mumbai, India
  • Kothari, J., Hinduja Hospital,Healthcare & Apex Kidney Foundation, Mumbai, India
  • Mohd shah, Alam, Apex Kidney Care, Mumbai, India
  • Gupta, Virendra, Apex Kidney Care, Mumbai, India
  • Dedhia, Paras, Apex Kidney Care, Mumbai, India
Background

Studies have shown an association between higher ultrafiltration rate and mortality in prevalent dialysis patients. Ultrafiltration rate exceeding 10mL per kg per hour has been associated with greater mortality even when calculations are normalized to various anthropometric measurements.

Methods

We recorded interdialytic weight gain (IDWG) for one week of thrice a week prevalent dialysis patients. Also baseline characteristics of study population were noted. Our dialysis data is recorded in AXIS renal data solution (electronic health record designed and conceptualized by Nephrologist). IDWG was calculated as predialysis weight minus the post dialysis weight of the previous hemodialysis session.The ultrafiltration rate was calculated by dividing the ultrafiltration volume (ml) by the target dry weight (kg) and length of time of the dialysis session (hours). Average ultrafiltration rate for all 3 sessions of hemodialysis and percentages of dialysis session where UF rate exceeded 10mL per kg per hour were calculated. After preliminary data collection, we are planning to introduce electronic alert (e alert) within AXIS system whenever ultrafiltration rate exceeds 10mL per kg per hour. This e alert will be sent to patient's caregiver as well as will serve as a teaching tool for dialysis nurse.

Results

Of the 387 subjects, 62% were males. The average age was 53.1± 13.6 years. The average dialysis vintage was 4.0 ± 3.4 years. 33.6 % had diabetes, 85.5 % had hypertension and 10.0 % had history of ischemic heart disease. Average UF rate of first session of week (after weekend) was 13.8 ± 5.7mL per kg per hour. Average UF rates of mid week and last session of week were 10.5 ± 10.5 and 10.0 ± 4.5mL per kg per hour respectively. About 75.7% of HD sessions after weekend had UF rate more than 10mL per kg per hour whereas 48.3 % and 47.8 % sessions of remaining week exceeded safe UF rate limits.

Conclusion

About 75% of dialysis sessions after weekend gap exceeded safe limits for ultra-filtration rates in prevalent dialysis patients. This calls for quality improvement initiative to improve knowledge and to monitor in change in behavior among dialysis patients, caregivers and providers regarding safe limits of UF rate.