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Abstract: PO1092

Healthcare Staff Acceptance of Ultrafiltration Rate Recommendations Made by a Novel Feedback Controller

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Tapia, Mirell, Renal Research Institute, New York, New York, United States
  • Rivera Fuentes, Lemuel, Renal Research Institute, New York, New York, United States
  • Rogg, Sabrina, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Preciado et al. have identified relative blood volume (RBV) targets during hemodialysis (HD) that are associated with improved patient survival [1]. Attainment of RBV targets requires frequent adjustments to the ultrafiltration rate (UFR) by the dialysis nurse, which is logistically not feasible. We developed a novel proportional-integral controller that takes RBV data from the CLiC® device as an input and provides UFR recommendations to guide the RBV curve into the desired targets. We investigated the degree to which the nurses accepted the UFR recommendations made by this controller.

Methods

We conducted a prospective, interventional study in chronic HD patients at 3 Dialysis Clinics in Manhattan. RBV was measured with the CLiC® device. CLiC® and Fresenius 2008T HD machine data were fed into a research laptop running the UFR Feedback Controller software. UFR recommendations (generated every 10 minutes) were evaluated by dialysis nurses who then either implemented or rejected them as they deemed clinically appropriate.

Results

56 HD treatments from 14 subjects had analyzable data. Out of 1,038 UFR recommendations, 926 (89.2%) were accepted, while 112 (10.8%) were overridden. For 25 HD treatments which had at least one recommendation overridden, we analyzed the direction and magnitude of disagreement between the Controller-suggested UFR and the implemented UFR (Fig. 1). From the overridden controller recommendations, 20 implemented UFRs were greater than the respective Controller-suggested UFRs, another 70 implemented UFRs were less than 100 mL/h lower than the Controller-suggested UFRs. Together, these two categories made up 83% of all “disagreements” between the nurse and the Controller. Of the total of UFR recommendations overrides, 59.6% were due to staff preference in the absence of clinical symptoms.

Conclusion

There was a high proportion (≈90%) of Controller-UFR recommendations that were accepted by the nurses. Of the few cases where nurses overrode the recommendation, the majority (≈60%) were due to “staff preference”, this is likely owed to the fact that the nurses exclusively attended one patient at a time for the entire HD session.

Funding

  • Commercial Support