A Dialysis Center Educational Video Intervention Increases Patient Self-Efficacy and Kidney Transplant Evaluations

Introduction: The optimal treatment for end-stage kidney disease is renal transplant. However, only 1 in 5 (21.5%) patients nationwide receiving dialysis are on a transplant waitlist. Factors associated with patients not initiating a transplant evaluation are complex and include patient specific factors such as transplant knowledge and self-efficacy. Research Question: Can a dialysis center-based educational video intervention increase dialysis patients’ transplant knowledge, self-efficacy, and transplant evaluations initiated? Design: Dialysis patients who had not yet completed a transplant evaluation were provided a transplant educational video while receiving hemodialysis. Patients’ transplant knowledge, self-efficacy to initiate an evaluation, and dialysis center rates of transplant referral and evaluation were assessed before and after this intervention. Results: Of 340 patients approached at 14 centers, 252 (74%) completed the intervention. The intervention increased transplant knowledge (Likert scale 1 to 5: 2.53 [0.10] vs 4.62 [0.05], P < .001) and transplant self-efficacy (2.55 [0.10] to 4.33 [0.07], P < .001. The incidence rate per 100 patient years of transplant evaluations increased 85% (IRR 1.85 [95% CI: 1.02, 3.35], P = .0422) following the intervention. The incidence rates of referrals also increased 56% (IRR 1.56 [95% CI: 1.03, 2.37], P = .0352), while there was a nonsignificant 47% increase in incidence rates of waitlist entries (IRR 1.47 [95% CI: 0.45, 4.74], P = .5210). Conclusion: This dialysis center-based video intervention provides promising preliminary evidence to conduct a large-scale randomized controlled trial to test its effectiveness in increasing self-efficacy of dialysis patients to initiate a transplant evaluation.

Human Factors Considerations in Designing a Portable Dialysis Device: Understanding Patients’ and Care Partners’ Needs for Increased Mobility

The objective of this study is to guide the designs of a portable dialysis device that allows patients with End-Stage Renal Disease (ESRD) greater mobility and flexibility to travel. We gathered patients’ and care partners’ motivations behind their travels along with the barriers they experience when planning an overnight trip. Using a quantitative analysis approach for the open-ended questions along with rank-order of response frequencies, our findings indicate that the majority of the motivations behind participants travel is to visit their family and friends but the participants find themselves either completely hindered or experience significant challenges when planning overnight trips where the designs of current dialysis devices and or the logistics of planning or scheduling treatments in an unfamiliar dialysis center outweigh the enjoyment of traveling. Our results give an estimate of parameters for the largest acceptable size and weight of a portable dialysis device that meets users’ needs. The results of this study help provide the designers of a portable dialysis device with better-targeted solutions to design a device that comfortably supports patients’ mobility and freedom of travel.

Pruritus Features in Children with End-Stage Renal Disease Underwent Dialysis: A Cross-Sectional Study

Objective. Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. Methods. This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. Results. Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman’s rho = 0 .42, P = 0.02 ) and serum level of parathyroid hormone (PTH) (Spearman’s rho = 0.42 , P = 0.04 ). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). Conclusion. Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children.

Rate of HCV Seroconversion And Its Associated Factors In Hemodialysis Patients

Background: CKD is a worldwide public health problem. HCV is the most frequent complication of patients on hemodialysis, it is very important to screen patients for HCV seropositivity, asit may lead to severe liver disease, complications in renal transplant and death. Aim: To find the incidence of HCV seropositivity and identify factors associated with hemodialysis patients at the Dialysis Center. Methodology: A Retrospective Cohort study conducted at Hemodialysis Unit, Sheikh Zayed Hospital, Lahore from January 2015 to December 2015. Secondary data was collected from all the record files of all the patients included in the study available at Sheikh Zayed hospital. Data was also collected by a questionnaire from patient to determine different variables. Data for age, gender, HCV seroconversion, number of transfusions, emergency dialysis at any other hemodialysis center, surgeries, previous history of HCV, dialyzer reuse and dental procedure etc. was collected and patients were divided in two groups according to HCV status at the end of study. Data for seroconversion was studied for relation with given risk factors using Chi-square test and odds ratios with 95% confidence interval. Binary logistic regression was used to see the adjusted odds ratio of various risk factors for seroconversion. P-value ≤0.05 was considered significant. Results: The mean age of the patients was 43.40±16.37 years. The frequency of previous transfusions was 120(48%) The frequency of emergency dialysis outside Shaikh Zayed Hospital was 76(30.4%). The frequency of surgeries was 126(50.4%). The frequency of dental procedures was 102(40.8%). The mean duration of dialysis was 17.6±5.73. The incidence of HCV seroconversion in hemodialysis patients was 124(49.6%). Conclusion: We concluded that the incidence of HCV seroconversion in hemodialysis patients was 8.2% per year and over a period of six years nearly 49.6% who were undergoing dialysis in our dialysis center. Keywords: HCV seroconversion, hemodialysis patients

Effect of High-Flux versus Low-Flux Dialysis on the Rate of Bacteremia in Hemodialysis Patients

Bacteremia in dialysis patients is a major risk factor of mortality. The aim of this study was to assess the effectiveness of dialysis with high-flux versus low-flux dialyzer regarding risk of bacteremia in dialysis patients. This was a retrospective cohort study that included dialysis patients who underwent dialysis therapy at old dialysis center where old low-flux dialyzers were used and the new dialysis center where high-flux dialyzers were used. The rate of positive culture was more in high-flux group (37.0%) compared to low-flux group (24.5%), although the difference was not statistically significant (P = 0.13). The vascular access was mostly permanent catheter in high-flux group compared to low-flux group (48.9% vs. 28.6%, respectively; P = 0.06), while arteriovenous (AV) fistula was more prominent in low-flux group compared to high-flux group (65.3% vs. 47.8%, respectively; P = 0.06). This was reflected in the type of bacteria, which was mostly from Gram-positive family (Staphylococcus). The results showed higher risk of bacteremia in high-flux group as compared to low-flux group; however, permanent catheters were more prominent in high-flux group.

Outbreak and impact of coronavirus disease 2019 (COVID-19) on dialysis patients; Al Khezam dialysis center experience, Kuwait

Introduction: Coronavirus disease 2019 (COVID-19) is an outbreak due to SARS-CoV-2, declared by the World Health Organization (WHO) as a global pandemic in March 2020. Patients with underlying diseases, such as those with end-stage kidney disease (ESKD) on dialysis, are at greater risk. Objectives: The aim of our study to assess the outbreak and impact of COVID-19 on dialysis patients. Patients and Methods: Our study prospectively assessed and followed 442 patients with ESKD undergoing dialysis [390 patients on maintenance hemodialysis (HD) and 52 patients on peritoneal dialysis (PD)] for outbreak and impact of COVID-19 on these patients during the period from April 22, 2020 until March 23, 2021 in Al Khezam dialysis center, Kuwait. Age, gender, nationality, original kidney disease, history of hypertension (HTN), diabetes mellitus (DM), ischemic heart disease (IHD), congestive heart failure (CHF), bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), history of pulmonary embolism (PE) and source of infection were analyzed. Symptoms as fever, fatigue, cough, loss of smell and taste and chest pain were recorded, the need for ICU admission, mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO), medications were recorded. The need to shift to continuous renal replacement therapy (CRRT) and outcomes (complications and mortality) were analyzed. Results: Our study reported that 102 out of 442 (23%) dialysis patients [97 out of 390 (24.8%) HD patients and 5 out of 52 (9.6%) PD patients] got infected with COVID-19 and reinfection reported in 4 out of 97 (4%) COVID-19 HD patients. Around 27% of COVID-19 HD patients had fever, 19% had fatigue, 8% had cough, 4% had loss of smell, 4% had loss of taste, 4% had chest pain and 40% of COVID-19 PD patients had fever. Fifteen out of 97 (15 %) COVID-19 HD patients needed ICU admission, 12 out of 97 (12 %) COVID-19 HD patients needed MV. A 33 out of 97 (34%) COVID-19 HD patients and 4 out of 5 (80%) COVID-19 PD patients needed to switch to CRRT. Mortality was 17 (15 HD and 2 PD) out of 102 (16.6 %) COVID-19 dialysis patients and common causes of death were sepsis, myocardial infarction (MI), heart failure and PE. Conclusion: Outbreak and mortality of COVID-19 infection is high in ESKD patients undergoing dialysis compared with general populations. Strict protocol for prevention of COVID-19 should be undertaken in dialysis centers and encourage of home dialysis and highly protective COVID-19 vaccination priority for dialysis patients.

MO852MANAGEMENT OF PATIENTS UNDERGOING CHRONIC HEMODIALYSIS DURING THE COVID-19 PANDEMIC: FONDAZIONE POLICLINICO A. GEMELLI’S EXPERIENCE

Background and aim COVID-19 (COronaVIrus Disease 19) is an acute respiratory disease caused by SARS CoV 2 virus. The correlation between SARS-CoV2 infection and comorbidities is complex; patients with multiple comorbidities present often with the most severe symptoms that could potentially lead to death. Patients undergoing hemodialysis are generally frail and immunodeficient. This leads to a greater risk of contracting infectious diseases. In the literature, the estimated incidence of SARS-CoV2 infection is 3.24% in chronic hemodialysis patients. Method Fondazione Policlinico A. Gemelli is a COVID hospital. During the pandemic patients from several dialysis centers converged in our hospital. FPG has two dialysis centers, one for outpatients and one for inpatients. Patients admitted for COVID-19 infection have been treated in three different settings: 1. isolation room within the dialysis center; 2. Bedside; 3. In a COVID-19 dialysis center. We retrospectively collected data of patients treated from March 2020 to January 2021 and analyzed the SARS-CoV2 incidence in our center’s chronic hemodialysis patients. Results 66 hemodialysis patients affected by COVID-19 have been treated in our hospital from March 2020 to January 2021, 60 patients undergoing chronic dialysis and 6 patients diagnosed with acute kidney injury (AKI) stage III non-intensive care unit. Among chronic patients, 64 underwent chronic hemodialysis and 2 patients underwent peritoneal dialysis. Median age was 68.19 (46 males, 20 females), all patients had multiple comorbidities: 37.8% of patients had diabetes mellitus; 72.7% cardiovascular diseases and 16.6% a positive clinical history for cancer. Among the 6 AKI cases, 3 patients regained total kidney function; the other 3 had to continue renal replacement therapy. The mean hospital stay length was 18.5 days with a mean time of COVID-19 infection of 21.23 days. The overall mean Charlson Comorbidty Index was 6.21. Among the 66 treated patients, 43 were diagnosed with COVID-19-related pneumonia, 14 had the infection, no pulmonary involvement, but presented with other complications, and 5 patients resulted positive although asymptomatic. Among the 116 hemodialysis outpatients, only 4 presented with SARS-CoV2 infection, 3 were contacts of a positive family member and 1 resulted positive during a hospital stay for Clostridium Difficile infection. All patients required hospitalization. 14 (21%) patients died. Among the deceased patients, the mean age was 76.90 years (9 males, 3 females), mean Charlson Comorbidity Index was 7.3, mean hospital stay length was 9 days. Among patients who survived the disease the mean age was 76.92 years (34 males, 14 females), mean Charlson Comorbidty Index was 5.87 and mean hospital stay length was 19.47 days. Statistical significance was reached for age (p value 0.005) and Charlson Comorbidty Index (p value 0.39), but not for mean hospital stay length (p value 0.13). All COVID-19 patients were treated with bicarbonate hemodialysis and a Theranova 400 Baxter® filter. This filter was chosen for its efficiency on medium-size molecules removal (between 25 kDa and 60 kDa) that may be associated with inflammation. Bedside treatments were performed using the Genius© Fresenius system. Each treatment lasted 180 minutes, in order to reduce the time of exposure to COVID-19 of medical staff and the risk of virus spread on one hand, but still ensuring an optimal and complication-free treatment to patients. Conclusion Our experience seems to confirm the national data collected so far, both in terms of patients’ outcomes and mortality rate. Our study confirms that age is a risk factor for mortality. How to properly manage chronic hemodialysis patients affected by COVID-19 remains a challenging and burdensome question. However, there is the need of new flexible solutions that guarantee the patients and the medical staff’s safety on one hand and a personalized management on the other.

Integrated management is effective in the prevention and control of COVID-19 in the blood purification center: joint efforts from multiple departments

Background During the outbreak of new coronavirus pneumonia, many hospitals in China became the designated hospitals for the treatment of new coronavirus pneumonia. The goal was to develop rapid and effective prevention and control methods for blood purification centers. Research design and methods The medical department, hospital department, nursing department, and blood purification center jointly set up a multi-department integrated COVID-19 prevention and control management team to manage the blood purification center. The efforts included the establishment of the continuous renal replacement therapy (CRRT) team for COVID-19, the integrated training and assessment of medical personnel, the integrated education of patients and their families, and the integrated management of the workflow of the hemodialysis room. Results No infected persons, including medical staff, patients, and their families, have been found in the dialysis center. After multi-departmental integrated training, the theoretical performance of medical staff in our dialysis center has increased from 82.36 ± 8.10 to 95.29 ± 4.95 (p < 0.05), and the unqualified rate dropped from 23.21 to 1.78% (p < 0.05). In addition, the three operational skills evaluation scores have also been significantly improved, from 86.00 ± 4.02, 88.01 ± 6.20, 92.01 ± 2.46 to 95.90 ± 0.30, 97.21 ± 0.87, 96.00 ± 1.00 (p < 0.01), and the passing rate from 80.36 to 100% (p < 0.05). Conclusion Medical staff’s knowledge of novel coronavirus pneumonia prevention and control can be improved by multi-sectoral integrated management, and CRRT treatment of COVID-19 patients is effective.