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Kidney Week

Abstract: TH-PO332

The Effects of Negotiation on Discordant Home Hemodialysis Patients

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Sanchez Escuredo, Ana, UHN, Toronto, Ontario, Canada
  • Salah, Naeim Gawad, UHN, Toronto, Ontario, Canada
  • Faratro, Rose, UHN, Toronto, Ontario, Canada
  • D'Gama, Celine, UHN, Toronto, Ontario, Canada
  • Chan, Christopher T., UHN, Toronto, Ontario, Canada
Background

Home hemodialysis (HHD) has demonstrated superior clinical outcomes, improved quality of life and enhanced treatment flexibility in comparison to 3days/week incenter HDs.Nonetheless, some patients are discordant to their dialysis prescription and require a negotiation program to maintain their normal lifestyle and ameliorate their illness behavior.

Methods

Retrospective single center observational study of all prevalent HHD patients at UHN (2018-2022).Demographic and clinical data were extracted from clinical charts.Negotiation was defined as weekly contact between nurses and patients by phone, email or clinical visit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications.Patients were defined as concordant, concordant with agreement with at least 75%of dialysis prescription and discordant for those skipping/shortening HHD sessions without prior agreement with the clinical team.

Results

From 94patients, 33(35%)required negotiation:15(16%) were concordant patients with agreement and 18(19%) discordant patient.There were no demographic differences between groups. Patients requiring negotiation presents higher median time on HHD (7.6years vs 4.3years for concordant patients).Discordant patients tended to be younger and were less likely to be listed for kidney transplant(figure 1).There were no differences in hospitalisation/technique complications amongst the 3 groups.

Conclusion

A third of HHD patients require negotiation to maintain their lifestyle and safety.Those patients requiring negotiation did not present with more hospitalisation or technique complications than concordant patients.We speculate that a negotiation program should be implemented in HHD centers to ameliorate patient concordance and mitigate attrition.