S-56-4: ESTABLISHING A NEPHROLOGY-LED AMBULATORY BLOOD PRESSURE MONITORING SERVICE IN SINGAPORE

Abstract

Objective: The prevalence of hypertension in Singapore is increasing, and 64.3% of patients with hypertension are not able to meet treatment targets. Management of hypertension in patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD) is challenging due to higher risk of resistant and masked hypertension, autonomic dysfunction, and blood pressure fluctuations related to intermittent haemodialysis (HD) treatment. Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosis and management of hypertension and can provide better insight into patients blood pressure patterns and response to treatment. ABPM for a 24-hour period is an established service with the Cardiology department at our hospital. However, access remains limited, and utilizing another departments resources increases costs and may be a burden for our patients. Our aim was to develop a nephrologist-led ABPM service to increase accessibility and utilization of ABPM in our department and provide the option of 48-hour ABPM for patients on haemodialysis to be able to track blood pressure trends on both dialysis and non-dialysis days. Design & methods: We procured a Schiller BR-102 ambulatory blood pressure monitor with battery compatibility ensured to be able to run for 48 hours. Other factors in machine selection were portability, and ease of use of machine interface and reporting software. Two cuff sizes were obtained to increase utility for patients of different body habitus. The device underwent a review by hospital operations management team for meeting standards for safety and patient data protection. Scheduling and nursing workflows were established Nurses were trained in pre and post procedure checks with the aid of a nursing checklist, and a patient log was drafted for listing timing of medications, haemodialysis, and sleep and wake times. A patient information sheet was also created with a phone hotline to call during office hours in the event of complications. The service was then integrated into the electronic health reporting system. Reporting guidelines were adapted from the 2019 HOPE Asia Networks expert panel consensus guidelines for ABPM in Asia (2019). Results: Pilot studies were run on two healthy subjects to ensure the process flowed smoothly and that the machine was in working order., Recruiting of patients for ABPM service is ongoing. Conclusions: Establishing an ABPM service in our nephrology practice is feasible and will facilitate improved management of hypertension in our complex patient population.