G STONIER, E TAN
Regional Renal Unit, Waikato Hospital, Hamilton, New Zealand
Aim: To ascertain the effects of increased Home Haemodialysis (HHD) training intensity on overall training time.
Background: Our renal unit has 95 prevalent HHD patients. The same staff train and subsequently look after these patients. Pre-2011, conventional training takes 8-12 weeks: Thrice Weekly (TW) coinciding with dialysis, with gaps in the week. From 2011 onwards, an Intensified Training Regime (ITR) was employed: Four Times Weekly (FTW).
Methods: Data was retrospectively collected from 2005-2015 for patients undergoing HHD training (which included new and previously trained patients). The age, gender, ethnicity, diabetic status and training duration were compared between the groups of different intensities: TW versus FTW (using t-test for statistical analysis).
Results: The baseline characteristics of these cohorts (TW versus FTW) were as follows: total numbers (103 versus 139 patients), average age (50.0±1.1 versus 50.8±1.0 years), males (64.3% versus 74.8%), indigenous people (61.38% versus 67.6%) and diabetes status (49.5% versus 53.9%). The ITR reduced overall training times (9.55±0.39 versus 7.4±0.27 weeks, p<0.001). Sub-analysis showed that only newly trained patients benefited from the ITR (10.98±0.39 versus 8.19±0.28 weeks, p<0.001). For previously trained patients, retraining times remained unchanged (5.78±0.53 versus 5.03±0.52 weeks, p=0.32).
Conclusions: The ITR was associated with significantly shorter overall training times. This improvement was only seen in newly recruited patients but not in previously trained patients.
Discussion: The ITR utilises the training week more efficiently; allowing earlier HHD establishment and faster through-put of patients, which may translate to cost savings. However, this arrangement requires more staffing commitment for training, with potentially less time to look after existing patients. Also, a more relaxed training regime (TW) could be considered when retraining patients who were previously trained.