MO882PATIENTS' UNDERSTANDING AND EXPERIENCE OF COVID-19 PANDEMIC AMONGST IN-CENTRE HAEMODIALYSIS POPULATION IN A SINGLE UK CENTRE

Background and Aims Patients with end-stage kidney disease on dialysis are susceptible to severe COVID-19 infections. However, during the pandemic, many renal patients were unable to ‘shield’ fully due to the ongoing need to attend the dialysis unit for treatment. With a significant proportion of our haemodialysis population coming from socially deprived and ethnic minority background (38%), we aimed to explore patients’ understanding and experience of COVID-19 pandemic. Method This was a cross-sectional survey of patients receiving in-centre haemodialysis from one centre in England conducted during July 2020, three months after the first UK national lockdown. The questionnaire consisted of 18 questions exploring patients’ awareness of COVID-19 pandemic, understanding of ‘shielding’, use of face covering, and their experience of haemodialysis treatment as well as accessing healthcare during COVID-19 pandemic. Those with language barriers were offered assistance and verbal translation by haemodialysis nurses, if possible, to complete the questionnaire. Results In total, 232 patients (of a total of 479 in-centre dialysis patients, 48% response rate) completed and returned the questionnaire. Of these, 29 (12.5%) patients required help with the questionnaire due to language barrier. Mean age was 62 (SD 16) years, 63% were male, 53% were from ethnic minorities and 45% were from the most deprived area (MDI Decile 1). A third of the respondents lived with 3 or more adults at home and a quarter lived with one or more child. Majority of the patients (97%) were aware of COVID-19 pandemic, and most received information on COVID-19 from the news (87%). Dialysis staff (43.1%), family and friends (32.6%), internet (31%) and general practitioners (20.3%) were also key sources of information. Despite this, 17.2% of the patients did not know about ‘shielding’. Even though 3 in 4 patients stated that they were ‘always’ or ‘often’ able to ‘shield’, when prompted with scenarios, significant number of patients in fact felt that they were unable to shield when travelling to dialysis (56%), during dialysis (35%) or when shopping (17%). Majority of the patients (89%) said that they wore face covering and 28% self-isolated from the rest of household during the first peak of pandemic. 83% practised ‘social distancing’ at dialysis units but 5% did not and 6% felt unable to do so. Almost a quarter of the patients (23%, 54 patients) felt unwell during the first wave of COVID-19. Majority (50%) of them sought medical help by informing the dialysis unit, whilst 26% contacted their GP and 38% attended emergency departments. Of these 54 patients, 35% had difficulties accessing medical help, especially from primary care. One in four patients felt that their dialysis experience had changed during the pandemic: 10% increased use of private taxis or used different travel services, 3.5% reported increased travel time, 8% dialysed at a different unit, 5% experienced longer waiting time to start dialysis sessions and 4% had dialysis frequency reduced . Almost a third (29%) of the patients knew of someone in the dialysis unit who had COVID-19 infection during the first wave of pandemic. Conclusion COVID-19 posed significant challenges for patients receiving in-centre haemodialysis. Despite their high susceptibility to severe COVID infection, significant number of patients was not aware of ‘shielding’ or able to ‘shield’ effectively. Some also experienced difficulties accessing medical help and a quarter reported change of transport or dialysis arrangement during the pandemic.

P1539THE INFLUENCE OF DIFFERENT HEMODIALYSIS FREQUENCY ON MHD PATIENTS WAS ANALYZED BASED ON THE DATA OF THREE CONSECUTIVE YEARS

Background and Aims By analyzing the follow-up data of patients on maintenance hemodialysis (MHD) in the department of blood purification of the first affiliated hospital of Xi'an Jiaotong university from 2016 to 2018, the effects of different dialysis frequency on patients were compared and the continuous improvement of clinical quality was promoted. Method The general data of MHD patients in our center from 2016 to 2018 and annual laboratory monitoring indicators [including hemoglobin (HGB), calcium (Ca), phosphorus (P), parathyroid hormone (iPTH), serum albumin (ALB)] and their control rates were analyzed, and the differences in the above indicators of patients with hemodialysis frequency (2-times weekly, 5-times in two weeks and 3-times weekly) were compared. Results The proportion of patients older than 60 years old and the proportion of autologous arteriovenous fistula (AVF) increased year by year, while the use of the cuffed-tunneled catheter (TCCs) decreased. All indicators except iPTH have increased their control rates. Among the different dialysis frequencies: the average value of HGB and Ca was the highest at 3 times/week, and the control rate of P was not much different among the three groups. ALB was significantly lower in patients with 2 times/week than in other frequency groups (P<0.05). The average age of 3 times / week patients was significantly lower than 2 times / week and 5 times / 2 weeks (P <0.05). Conclusion In northwest China, the hemodialysis frequency to twice per week for most. The results of this study suggest that compared with the higher frequency, the major differences in the control rates are in albumin hemoglobin and serum calcium.

Predicting Residual Function in Hemodialysis and Hemodiafiltration – A Population Kinetic, Decision Analytic Approach

In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.888 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.

Predicting Residual Function in Hemodialysis and Hemodiafiltration – A Population Kinetic, Decision Analytic Approach

In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.808 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.