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Abstract: SA-PO984

Characteristics and Effectiveness of Dedicated Care Programs for Patients Starting Dialysis: A Systematic Review

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Attalla, Mirna, Queen's University, Kingston, Ontario, Canada
  • Friedman, Zoe, Queen's University, Toronto, Ontario, Canada
  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
Background

The transition period during dialysis initiation is associated with increased morbidity and mortality. Transitional care units are increasingly being used to reduce the risk of complications during this vulnerable period. The objectives of our systematic review were to determine the characteristics of existing transitional care programs and their effect on clinical outcomes.

Methods

We used a search strategy to search Embase, Ovid Medline, Web of Science, Cochrane Central and CINAHL for English-language studies that evaluated dedicated programs for management for incident dialysis patients; our timeline included studies published from start of database to date. Any study design was eligible, but we required the presence of a control group and patient-relevant outcomes (e.g. mortality, central venous catheter use, and quality of life). We extracted data describing the intervention, participant demographics, comorbidities, type of renal replacement therapy, and follow-up period. We assessed study quality using the Newcastle-Ottawa Quality Assessment Scale (NOQAS).

Results

The search strategy yielded 8557 studies; 62 full texts were evaluated and 9 studies with 13,033 patients were included. 6 studies evaluated in-center hemodialysis and 3 evaluated peritoneal dialysis. All included studies were observational. 5 studies were rated as high quality, with scores of 8-9 on the NOQAS evaluated programs that provided patient education, structured patient monitoring and a structured vascular access program. Three high quality studies that were similarly structured to provide intensive education and patient monitoring at the start of dialysis suggested a trend towards reduction of mortality and use of central venous catheters. However, study heterogeneity precluded meta-analysis. No studies evaluated for an effect on home dialysis or transplant uptake, and few collected feedback from patients and staff on their sustainability.

Conclusion

Few high-quality studies have evaluated dedicated programs for patients new to dialysis, and most only measure for an effect on mortality and vascular access. Further research is needed to design and evaluate these models of cares before widespread implementation, with an emphasis on patient-relevant outcomes, such as home dialysis uptake, transplant, and quality of life.