SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

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288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.331 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S144-S144

Author(s):

Azza Elamin ◽

Faisal Khan ◽

Ali Abunayla ◽

Rajasekhar Jagarlamudi ◽

aditee Dash

Keyword(s):

Clinical Outcomes ◽

Antibiotic Treatment ◽

Readmission Rate ◽

Blood Cultures ◽

Categorical Variables ◽

Gram Negative ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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The impact of surgical intervention on renal function in cystinuria

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0034 ◽

2018 ◽

Vol 40 (3) ◽

pp. 256-260 ◽

Cited By ~ 1

Author(s):

Serra Sürmeli Döven ◽

Ali Delibaş ◽

Hakan Taşkınlar ◽

Ali Naycı

Keyword(s):

Renal Function ◽

Radionuclide Imaging ◽

Surgical Intervention ◽

Renal Scarring ◽

Urinary Stones ◽

Surgical Interventions ◽

Significant Difference ◽

Before And After ◽

The Impact

ABSTRACT Introduction: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. Methods: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. Results: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. Conclusions: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.

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Biomarkers-based Personalized Follow-up in Chronic Heart Failure Improves Patient’s Outcomes and Reduces Care Associate Cost

10.21203/rs.3.rs-117453/v1 ◽

2020 ◽

Author(s):

Antonio Leon Justel ◽

Jose Ignacio Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Incidence Rates ◽

Primary Objective ◽

Economic Problem ◽

Functional Class ◽

Post Intervention ◽

Number Of Patients ◽

Before And After ◽

Ed Visits ◽

The Impact

Abstract BACKGROUNDHeart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF.METHODSThis is a real-world, before-and after-intervention trial, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before and after an intervention. The primary objective was the rate of readmissions, due to a HF event, post-intervention compared to pre-intervention. Secondary outcomes compared the rate of ED visits and the number of patients who had reduced NYHA score pre and post-intervention. A cost- analysis was also performed on these data.RESULTSAdmission rates significantly decreased by 41% after the intervention (total length of stay was reduced by 55%). The rate of ED visits was reduced by 55%. Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was €139,717.65 for the whole group over 1 year.CONCLUSIONSA personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care- associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Abstract W P299: Impact of an Institutional Guideline on Implementing Early Decompressive Hemicraniectomy (DHC) for Large Middle Cerebral Artery Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp299 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Casey Olm-Shipman ◽

Victoria Marquevich ◽

Jonathan Rosand ◽

Aman Patel ◽

Emad Eskandar ◽

...

Keyword(s):

Clinical Trials ◽

Guideline Implementation ◽

Rapid Identification ◽

Decompressive Hemicraniectomy ◽

Significant Difference ◽

Class 1 ◽

Before And After ◽

The Impact ◽

Mean Time

Background: Recent AHA Acute Stroke Guidelines endorse DHC (Class 1, Level B) based on clinical trials showing benefit of early DHC on outcome and mortality. In 2011, our multidisciplinary quality improvement team developed a process to translate DHC guideline recommendations into clinical practice. Methods: Our consensus guideline includes a tool (STATE Criteria, based on inclusion/exclusion criteria of DHC clinical trials) to rapidly identify and triage potential DHC candidates, and provide specific guidelines for pre- and post-surgical management, adjunctive therapy, and DHC after IV/IA thrombolysis. Patients meeting all STATE Criteria including age ≤ 60 years are sent for urgent DHC. Patients meeting all criteria except age ≤ 60 years receive DHC only if age < 75 years and Neurology and Neurosurgery teams reach consensus about benefit. Patients not meeting criteria are observed and referred for DHC if criteria are met within 48 hours of onset. The guideline was disseminated to all stakeholders via email, conferences, and intranet. In this study, we retrospectively analyzed process and outcome measures for DHC before and after guideline implementation in February 2011. Results: Of 1518 stroke patients age ≤ 60 years admitted between January 2007 and April 2014, 47 (3%) received DHC (22 pre- and 25 post-guideline implementation; 28% female, 13% Hispanic). Mean admission NIHSS was similar (17±7 vs 18±5; p=.82). Mean time from admission to DHC improved significantly from 45±30 hours to 29±18 hours (p=0.04). The percentage of patients undergoing DHC beyond 48 hours decreased from 27% to 16% (p=0 .35). The degree of midline shift evident on CT or MRI prior to DHC significantly decreased from 9±4 mm to 5±4 mm (p=.01). There was no significant difference in length of stay, frequency of tracheostomy, gastrostomy, pneumonia, or urinary tract infection, or percentage of patients who died within 30 days of DHC. Conclusion: Our institutional guideline has facilitated the rapid identification and triage of patients with large MCA stroke to DHC. Follow-up is ongoing to determine the impact of our guideline on functional outcome after stroke.

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Abstract 167: Impact of a Pharmacist-Led Outpatient Direct Oral Anticoagulation Service

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.167 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Geoffrey D Barnes ◽

Emily Ashjian ◽

Robert Yeshe ◽

Brian Kurtz ◽

Elizabeth Renner

Keyword(s):

Usual Care ◽

Patient Adherence ◽

Cohort Analysis ◽

Academic Medical Center ◽

Regression Modeling ◽

Clinical Event ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Background: Direct oral anticoagulants (DOACs) represent novel alternatives to vitamin K antagonists but present new challenges for appropriate prescribing and ongoing patient adherence. We assessed the impact of a pharmacist-led DOAC service on prescription appropriateness and patient adherence as compared to usual care. Methods: We performed a retrospective, observational, matched cohort analysis of patients prescribed a DOAC at a large academic medical center between September 20, 2013 and December 31, 2014. We compared a group of patients (n=129) who participated in a pharmacist-led DOAC service to a matched group (n=129) who received usual care using coarsened exact matching based on prescriber specialty, DOAC prescribed, indication for anticoagulation and age. Co-primary endpoints included the percentage of patients who had appropriate DOAC therapy (FDA-approved medication and dose based on indication and renal function) prescribed at baseline and at 3-6 month follow up after initiating the medication. Secondary endpoints included mean medication possession ratios (MPR) for patients who received at least 3 months of DOAC therapy and had available pharmacy records (n=171). We performed multivariable logistic regression modeling for appropriate prescription and multivariable linear regression modeling for MPR. Results: Patients in the two groups were well balanced across multiple demographic and comorbid factors. Patients in the pharmacist-led DOAC service were significantly more likely to have an appropriate combination of DOAC and dose prescribed for their indication at baseline as compared to usual care (92.2% vs. 77.5%; adjusted odds ratio [aOR] 3.02, p=0.006). This finding persisted at follow up (93.7% vs. 81.1%; aOR=2.92, p=0.016). There was no significant difference between groups in the number of patients determined to have an appropriate DOAC prescribed for an FDA-approved indication (independent of dose) in the pharmacist-led service (95.3%) vs usual care (93.0%) at baseline (aOR 0.93, p=0.901). Patients in the pharmacist-led service had a mean adjusted MPR of 91.8% compared to 79.3% with usual care (p=0.001) over a median follow up of 248 days. Conclusions: A pharmacist-led DOAC service increases appropriate dosing of DOACs at baseline and follow up as well as patient adherence to therapy. Associated costs and clinical event rates associated with pharmacist-lead DOAC management remain to be investigated.

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Preoperative Prediction of Postoperative Physical Function in Infected Diabetic Foot Ulcer Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00200 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0020

Author(s):

Stephanie P. Hao ◽

Jeff R. Houck ◽

Olivia Waldman ◽

Judith F. Baumhauer ◽

Irvin Oh

Keyword(s):

Wound Healing ◽

Physical Function ◽

Diabetic Foot ◽

Multivariate Model ◽

Prolonged Treatment ◽

Measurement Information ◽

Amputation Level ◽

Patient Reported ◽

The Impact

Category: Diabetes Introduction/Purpose: Diabetic foot ulcers (DFU) is a prevalent problem that can lead to devastating results such as limb loss if left untreated. Nevertheless, the prolonged treatment course can limit the patient’s overall function and quality of life. Utilization of Patient-Reported Outcomes Measurement Information System (PROMIS) in Orthopaedic practice has previously shown that preoperative PROMIS scores can predict postoperative outcomes in foot and ankle surgeries. However, PROMIS assessment has not been used to determine the impact of surgical treatment for DFU on patients’ physical function. We sought to investigate the impact of preoperative PROMIS scores (Physical Function (PF), Pain Interference (PI), Depression (D)), demographic and laboratory values on postoperative PF in this unique patient population. Methods: From an academic orthopaedic surgeon’s practice, we identified infected DFU patients who underwent surgical interventions between February 2015 and November 2018 using ICD-10 code E11.621 (n=240). Patients with at least 3 consecutive visits, 3 month minimum post-surgical follow up and completed PROMIS Computer Adaptive Testing (CAT) assessments for each visit were included (n=92). Demographic data, BMI, medical comorbidities, Hemoglobin A1C, procedure performed, and wound healing status were collected. Amputation level was categorized as the following: 0 = irrigation & debridement (I&D) (n=39), 1 = forefoot amputations (n=46), 2 = mid/hindfoot amputations (n=14), 3 = Syme or above amputations (n=12). Uni- and multivariate analysis were performed to identify factors affecting the post-operative PF within the cohort. Spearman’s rank correlation coefficient, Chi-Squared tests and multidimensional modelling were applied to all variables’ pre-operative and post-operative time points. Based on the results, we formulated a numeric equation to predict post-surgical PROMIS PF. Results: The mean age was 60.5 (33-96) and 4.7 (3-12) months follow up. Mean preoperative PF, PI, and D changed from 34.4, 58.7, 51.4 to postoperative 36.1, 58.8, 51.1, respectively (ΔPF = 1.7, ΔPI=0.1, ΔD = -0.3). Preoperative PF (p < 0.01), PI (p < 0.01), depression (p < 0.01), chronic renal failure (p < 0.02) and amputation level (p < 0.04) showed significant univariate correlation with post-operative PF. Multivariate model (r = 0.6) revealed postoperative PF is predicted by initial PF (p = 0.094), depression (p= 0.008), amputation level (p = 0.002), and wound healing status (p = 0.001). The model had greater prediction power than the best univariate association (Δr = +0.17). Follow up length was not significant (p = 0.08). Conclusion: This study demonstrates that preoperative PROMIS scores combined with clinical factors can predict postoperative PF in DFU patients. Postoperative PF is predicted by: PFlongest_FU = 45.4 +0.20 PFinitial -0.21 Dinitial -6.1 (Heal =1) -2.9 (Amputation Category, 1-3). Additional diseased states not captured in this study and psychosocial variables may improve prediction power of the multivariate model. 70% of the patients’ initial PF were 1 to 2 standard deviations below the US population (n = 49; 28). Therefore, the reported model may serve as a valuable tool for patient education, setting expectations and post-surgical PF prediction in infected DFU patients.

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The COVID-19 pandemic and follow-up for shoulder surgery: The impact of a shift toward telemedicine on validated patient-reported outcomes

Journal of Telemedicine and Telecare ◽

10.1177/1357633x21990997 ◽

2021 ◽

pp. 1357633X2199099 ◽

Cited By ~ 1

Author(s):

Ramsey Sabbagh ◽

Nihar Shah ◽

Sarah Jenkins ◽

Jacob Macdonald ◽

Austin Foote ◽

...

Keyword(s):

Patient Satisfaction ◽

Short Form ◽

Total Shoulder Arthroplasty ◽

Patient Reported Outcome Measures ◽

Shoulder Surgery ◽

Phone Call ◽

Significant Difference ◽

Patient Reported ◽

The Impact

Introduction The emergence of COVID-19 and its ensuing restrictions on in-person healthcare has resulted in a sudden shift towards the utilization of telemedicine. The purpose of this study is to assess patient satisfaction and patient-reported outcome measures (PROMs) for individuals who underwent follow-up for shoulder surgery using telemedicine compared to those who received traditional in-person clinic follow-up. Methods Patients who underwent either rotator cuff repair or total shoulder arthroplasty during a designated pre-COVID-19 (traditional clinic follow-up) or peri-COVID-19 (telemedicine follow-up) span of time were identified. PROMs including the American Shoulder and Elbow Surgeons standardized assessment form, the three-level version of the EQ-5D form, the 12-Item Short Form survey, and a modified version of a published telemedicine survey were administered to participants six months post-operatively via phone call. Results Sixty patients agreed to participate. There was no significant difference between the pre-COVID-19 and peri-COVID-19 groups in patient satisfaction with their follow-up visit ( p = 0.289), nor was there a significant difference in PROMs between the two groups. In total, 83.33% of the telemedicine group and 70.37% of the in-person clinic group preferred traditional in-person follow-up over telemedicine. Discussion In a cohort of patients who underwent telemedicine follow-up for shoulder surgery during the COVID-19 pandemic, there was no difference in patient satisfaction and PROMs compared to traditional in-person clinic follow-up. This study indicates that while the majority of participants preferred face-to-face visits, patients were relatively satisfied with their care and had similar functional outcome scores in both groups, despite the large disruption in healthcare logistics caused by COVID-19.

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Nonresponder bias in hand surgery: analysis of 1945 cases lost to follow-up over a 6-year period

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211045627 ◽

2021 ◽

pp. 175319342110456

Author(s):

Paul H. C. Stirling ◽

Paul J. Jenkins ◽

Nathan Ng ◽

Nicholas D. Clement ◽

Andrew D. Duckworth ◽

...

Keyword(s):

Postoperative Outcome ◽

Hand Surgery ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Level Of Evidence ◽

Loss To Follow Up ◽

Significant Difference ◽

Patient Reported ◽

The Impact

The primary aim of this study was to identify factors associated with nonresponse to routinely collected patient-reported outcome measures (PROMs) after hand surgery. The secondary aim was to investigate the impact of nonresponder bias on postoperative PROMs. We identified 4357 patient episodes for which the patients received pre- and 1-year postoperative questionnaires. The response rate was 55%. Univariate and regression analyses were undertaken to determine factors predicting nonresponse. We developed a predictive model for the postoperative Quick version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores for nonresponders using imputation. Younger age, increasing deprivation, higher comorbidity, worse preoperative QuickDASH scores and unemployment predicted nonresponse. No significant difference in mean postoperative QuickDASH score was observed between the responders, and the scores for the responders combined with the predicted scores for the nonresponders. Preoperative function was the primary predictor of postoperative outcome. These results challenge the dogma that ‘loss to follow-up’ automatically invalidates the results of a study. Level of evidence: III

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Impact of Surgical Site Infection To Outcome In Patients With Operatively Treated Tibial Plateau Fractures– A Retrospective Multicenter Study

10.21203/rs.3.rs-154378/v1 ◽

2021 ◽

Author(s):

Ralf Henkelmann ◽

Karl-Heinz Frosch ◽

Richard Glaab ◽

Meinhard Mende ◽

Christopher Ull ◽

...

Keyword(s):

Surgical Site Infection ◽

Multicenter Study ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Site Infection ◽

Significant Difference ◽

Patient Reported ◽

The Impact ◽

Retrospective Multicenter Study

Abstract Background: Tibial plateau fractures (TPF) can be a life changing injury. Surgical site infection (SSI) occur in 3-10% and is a feared complication. Aim of this study was to evalute the impact of SSI to outcome in patients with operatively treated TPF.Methods: We conducted a retrospective multicenter study in seven participating countries. Between January 2005 and December 2014 all participating centers have followed up patients with SSI. In addition, three centers followed up patients without SSI as a reference group. Descriptive data and follow up data with patient reported outcome scores (KOOS, Lysholm) were evaluated. Statistic analyses were performed with IBM SPSS and two-sided tests to the significance level of α = 0.05. Results: In summary, 287 patients (41 with SSI and 246 without SSI) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with a SSI had a significant poorer Outcome in KOOS5 (48.7 ± 23.2 vs. 71.5 ± 23.5; p < 0.001) and Lysholm (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) compared to patients without SSI. This significant difference was also evident in the KOOS subscores pain (57.9 ± 22,9 vs. 75.0 ± 22.3; p < 0.001), symptoms (54.5 ± 28.8 vs. 75.4 ± 23.4; p < 0.001), ADL (48.8 ± 27.5 vs. 80.5 ± 22.6; p < 0.001) and QOL (37.8 ± 31.5 vs. 56.4 ± 30.2; p = 0.001).Conclusion: Patients with SSI differed significantly from patients without SSI in terms of gender, smoking and drug addiction. The trauma-associated data showed a significant difference in the severity of fracture morphology, concomitant injuries (especially open fracture and compartment syndrome), and the incidence of polytraumata. In terms of PRO, a significantly poorer outcome was recorded in patients with SSI.

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Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration

Clinical Kidney Journal ◽

10.1093/ckj/sfaa058 ◽

2020 ◽

Author(s):

Enrique Montagud-Marrahi ◽

Jose Broseta ◽

Diana Rodriguez-Espinosa ◽

Rodas Lidia ◽

Evelyn Hermida-Lama ◽

...

Keyword(s):

Total Carbon ◽

Bicarbonate Concentration ◽

Sodium Potassium ◽

Number Of Patients ◽

Before And After ◽

Key Factor ◽

Definition Of ◽

The Impact ◽

Hospital Clinic

Abstract Background Metabolic acidosis is a common problem in haemodialysis patients, but acidosis overcorrection has been associated with higher mortality. There is no clear definition of the optimal serum bicarbonate target or dialysate bicarbonate. This study analysed the impact of reducing dialysate bicarbonate from 35 to 32 mEq/L on plasma bicarbonate levels in a cohort of patients treated with online haemodiafiltration (OL-HDF). Methods We performed a prospective cohort study with patients in a stable chronic OL-HDF programme for at least 12 months in the Hospital Clinic of Barcelona. We analysed pre- and post-dialysis total carbon dioxide(TCO2) before and after dialysate bicarbonate reduction from 35 to 32 mEq/L, as well as the number of patients with a pre- and post-dialysis TCO2 within 19–25 and ≤29 mEq/L, respectively, after the bicarbonate modification. Changes in serum sodium, potassium, calcium, phosphorous and parathyroid hormone (PTH) were also assessed. Results We included 84 patients with a 6-month follow-up. At 6 months, pre- and post-dialysis TCO2 significantly decreased (26.78 ± 1.26 at baseline to 23.69 ± 1.92 mEq/L and 31.91 ± 0.91 to 27.58 ± 1.36 mEq/L, respectively). The number of patients with a pre-dialysis TCO2 >25 mEq/L was significantly reduced from 80 (90.5%) to 17 (20.2%) and for post-dialysis TCO2 >29 mEq/L this number was reduced from 83 (98.8%) to 9 (10.7%). PTH significantly decreased from 226.09 (range 172–296) to 182.50 (125–239) pg/mL at 6 months (P < 0.05) and post-dialysis potassium decreased from 3.16 ± 0.30 to 2.95 ± 0.48 mEq/L at 6 months (P < 0.05). Sodium, pre-dialysis potassium, calcium and phosphorous did not change significantly. Conclusions Reducing dialysate bicarbonate concentration by 3 mEq/L significantly and safely decreased pre- and post-dialysis TCO2, avoiding acidosis overcorrection and improving secondary hyperparathyroidism control. An individualized bicarbonate prescription (a key factor in the adequate control of acidosis) according to pre-dialysis TCO2 is suggested based on these results.

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