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Kidney Week

Abstract: FR-PO525

Hemodialysis Program in a Subacute Care Facility for ESRD Patients With Tracheostomy

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Xu, Guoping, The Permanente Medical Groups, Oakland, California, United States
  • Halick, Gary V., Kaiser Permanente, Oakland, California, United States
  • Pravoverov, Leonid, The Permanente Medical Groups, Oakland, California, United States
  • Nabong-Salem, Ritchie M., The Permanente Medical Groups, Oakland, California, United States
  • Zheng, Sijie, The Permanente Medical Groups, Oakland, California, United States
Background

ESRD patients with tracheostomy require long-term mechanical ventilation in addition to need for maintenance dialysis. Due to regulations in California, majority of such patients have prolonged acute hospital stays due to lack of availability of a lower level of care facility, capable of providing ventilation care and hemodialysis. Need for these services increased during the COVID 19 pandemic. Kaiser Permanente Northern California (KPNC) is an integrated health care system providing health care for 4.6 million members. Partnering with a large dialysis organization (LDO) and a local Subacute Care facility (SAC), a program has been developed to provide home hemodialysis for patients requiring long-term mechanical ventilation using Low Dialysate Volume Approach (LDVA) machines.

Methods

The program was initiated in Q4 2017. A set of clinical criteria for admission was developed between the LDO, SAC and KPNC. Weekly meetings with physicians, dialysis nurses, and SAC staffs were conducted to review the potential candidates currently hospitalized in one of twenty-one KPNC hospitals. Dialysis has been performed by a HD nurse four times a week (M-T-Th-F) for 3-3.5 hours for each dialysis treatment. Each treatment was conducted using a LDVA machine with standard LDVA prescriptions using a Watson calculator to achieve a weekly Kt/V above 2.1.

Results

Since the inception of the program, 45 patients have been admitted to the program, 24 female and 21 male patients. The mean age is 65 (±13) on the date of admission. The average length of stay per patient at an acute hospital prior to admission was 125 days, and after the admission, the total days in the SAC is 7,498 days, an average of 167 days per person. Total acute hospital re-admission days after admission to the program is 1,071 days, an average of 25 days per patient (range: 0 to 115 days). Nine patients are currently residing in the SAC.

Conclusion

It is feasible to provide hemodialysis care for patients requiring long term mechanical ventilation at the appropriate level of care. This approach reduces the patient length of stay (LOS) in acute hospitals and burden to critically stretched healthcare system. Further discussion with local regulatory agencies is needed to develop additional models of care to effectively deliver dialysis to patients requiring facility-based long-term care.