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Kidney Week

Abstract: SA-PO624

Rural Alaskan Experience Insourcing Innovative Dialysis Technology

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Russell, Daniel, Mat Su Regional, Palmer, Alaska, United States
  • Krier, Alyssa, Mat Su Regional, Palmer, Alaska, United States
  • Bush, Amanda L., Mat Su Regional, Palmer, Alaska, United States
  • D'Alessandri-Silva, Cynthia J., Outset Medical, San Jose, California, United States
Background

Patients requiring dialysis in rural areas often face obstacles for treatment such as distance to care, financial limitations, and mistrust of the medical community. Studies have revealed moving geographic location of medical services closer, has a positive impact on health, economic and psychosocial states. Alaska has a paucity of acute dialysis services outside of the major cities like Anchorage and Fairbanks, leading to significant cost and complexity to the delivery of care to patients in these areas. Mat Su Regional hospital is a 125-bed hospital located an hour from Anchorage and operationalized a dialysis service line to improve access to care for rural patients in Palmer, AK using an innovative dialysis system, Tablo®. This describes the first year of Intermittent Hemodialysis (IHD) and Sustained-Low Efficiency Dialysis (SLED) treatments.

Methods


A retrospective chart review through the hospitals Electronic Health Records (EHR) was performed on all IHD and SLED treatments since implementation in February 2022.

Results

Since implementation of dialysis services in February 2022, there were 340 combined IHD and SLED treatments in the hospital. Only 1 patient was transferred for care compared to 70 patients the year prior. Training for ICU nursing staff consisted of Tablo hub training modules, 2-hour hands on training and 2- 12-hour treatments with preceptor on the device. In the ICU there were 23 unique patients with 65 total SLED treatments. CLABSI rate was 0% and mortality rate was 43% (Fig 1) with 70% of those patients being male. Most treatments where longer than 10 hrs. (98%) and 49% used automated saline flushes as method for anticoagulation and 9% of treatments ended due to clotting (Fig 2). There was a 4.3% COVID rate.

Conclusion

Implementation of a new dialysis service line using Tablo decreased hospital transfers and displacement of patients in rural Alaska. Mortality rates were slightly better than national averages as were clotting events. Training of staff was relatively easy which allowed hospital wide adoption. More research is needed to increase dialysis services into rural areas for better patient outcomes.