C VAN EPS1, J JEFFRIES1, W MIDDLETON1, C HAWLEY1, S CAMPBELL1, D JOHNSON1, N ISBEL1, D MUDGE1, Y CHO1, M FAHIM1, R FRANCIS1, M BURKE1, K TAN2
1Princess Alexandra Hospital, Woolloongabba, Australia, 2Logan Hospital, Meadowbrook, 4131
Background: Increased weekly haemodialysis hours may improve symptom burden and mortality. However, compliance with dialysis prescription in home haemodialysis patients is not well studied. This study examines adherence with prescribed dialysis hours in home haemodialysis patients who are not remotely monitored.
Methods: The number of dialysis hours performed by each patient over a period of 1-4 months between November 2017 and April 2018 was calculated using readings of the number of hours each haemodialysis machine has run, acquired by staff during home visits from the back of the machine. Adjustment was made for of dialysis away from home, set up and machine maintenance and cleaning time. This was compared with number of hours prescribed as documented in patient’s medical records. With Ethics Committee approval, patients were not aware of this change.
Results: Population: N=54 (100% home haemodialysis population), Age 53 (44-63) years, 26% Female, Diabetes 28%. Duration between the 2 readings was 11 (7-17) weeks. Percentage of prescribed hours dialysed: >=90% hours: 52%, 70-89% hours: 30%, 50-69% hours: 11% and <50% hours: 7%. Average number of hours/week performed was 16+/-7. 41% of patients dialysed <15 hours/week. 46% were prescribed, but only 35% performed, >=18hours/week.
Conclusion: Recording the hours haemodialysis machines have been running provides a useful estimate of the haemodialysis hours being completed at home. It is minimally intrusive on patient privacy and requires no special equipment and little additional staff time. It does not provide information on exact haemodialysis session frequency or duration being performed. Rates of poor compliance with prescribed dialysis hours in home patients are significant and may contribute to the lack of consistent improvement in outcomes seen in many clinical trials.
Dr William Middleton is a medical registrar currently preparing for his Royal Australasian College of Physicians exams. He is hoping to pursue further training and a future career in renal medicine.