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Kidney Week

Abstract: SA-PO620

Implementing a Protocol for Incremental Hemodialysis in Incident Patients with ESKD: A Quality Improvement Project

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Taha, Ali, McGill University Health Centre, Montreal, Quebec, Canada
  • Messina, Alexander, McGill University Health Centre, Montreal, Quebec, Canada
  • Tom, Alexander, McGill University Health Centre, Montreal, Quebec, Canada
  • Altar, Reman Inocencio, McGill University Health Centre, Montreal, Quebec, Canada
  • Filteau, Nancy, McGill University Health Centre, Montreal, Quebec, Canada
  • Blum, Daniel, Hopital General Juif, Montreal, Quebec, Canada
  • Trinh, Emilie, McGill University Health Centre, Montreal, Quebec, Canada
  • Weber, Catherine L., McGill University Health Centre, Montreal, Quebec, Canada
Background

Incremental hemodialysis (HD) is the process whereby the frequency of HD is adapted to the patient’s residual kidney function, initially starting at twice a week with an increase based on clinical indications. Incremental HD potentially facilitates the transition to HD, reduces patient and caregiver burden, improves quality of life and reduces costs. We sought to increase the number of patients commenced on incremental HD at a tertiary care academic center and to develop a safe process to monitor these patients.

Methods

We performed a prospective cohort quality improvement study. Starting November 1 2022, we aimed to start 75% of eligible incident chronic HD patients on incremental HD within 1 year. Eligible patients were defined as medially stable with no acute, active medical issues, and no indication for more frequent HD. The primary outcome measure was percentage of incident ESKD patients started on incremental HD. The balancing measure was the number of patients requiring transition to three-times per week HD. The incremental HD process was developed with input from all stakeholders.

Results

Between November 1 2022 and March 31 2023, among 35 incident chronic HD patients, 14 were eligible for incremental HD, of which 9 started incremental HD. As of May 2023, 6 patients remain on two-times per week HD and 3 patients required an increase to three-times per week HD. The process developed included a) a patient information sheet about incremental HD b) nursing education, c) a nurse led protocol whereby the patient performs a 24 hour urine collection for volume and the nurse completes a safety checklist every 6 weeks, and d) an alert system for the MD to review the patient’s HD prescription if they have uremic symptoms, are volume overloaded or hyperkalemic.

Conclusion

We successfully initiated 64% of eligible incident HD patients on incremental HD, of which two-thirds remained on twice-weekly HD. Our next steps will involve feedback from patients and healthcare staff through quantitative and qualitative surveys with the goal of optimizing our protocol and expanding it to all dialysis units at our center.