Dialysis Services Research Articles

MO819: The Negative Impact of Reuse of Dialyzers on Survival Rates of Dialysis Patients

Abstract BACKGROUND AND AIMS Until 2019, in Uzbekistan, disposable dialyzers for dialysis were reused several times due to underfunding of the system. But in 2018, the President of the Republic of Uzbekistan Shavkat Mirziyoyev signed a decree on improving the nephrological and dialysis services in the country. After that, there is a sharp increase in funding and attention to the provision of hemodialysis care to the population of our country. Thanks to this Resolution, since 2019, in all regions of Uzbekistan, only disposable dialyzers are used for hemodialysis. To prospectively study the negative impact of the reusable use of disposable dialyzers on dialysis patients in Uzbekistan. METHOD The study took place in three dialysis centers in the country at different levels. Our observation of 165 (90 men and 75 women) patients took place for 2 years: from the beginning of 2018 to the end of 2019. The average age of the patients was 49.7 ± 14.1 years. During the first 12 months (before the release of the decree of the President of the Republic and funding), dialysis patients underwent multiple uses of dialyzers. The next 12 months were completely switched to single use. The average age of the patients was 48.1 ± 14.3 years. The average duration of hemodialysis was 37 (6–252) months. Survival was assessed using the Kaplan–Meier method. The confidence interval was determined by Greenwood. RESULTS During the 24 months of observation, out of 165 patients, 29.1% (n = 48) patients died, 70.9% (n = 117) survived (of which 11 patients underwent Tx). During 1 year of follow-up (the period of repeated use of disposable dialyzers), 21.2% (n = 35) patients died, 78.8% (n = 130) survived and continued to receive hemodialysis (6 patients Tx). A total of 68.6% (n = 24) of patients died from cardiovascular complications. The survival rate for 1 year (miltiple use period) was S(t) = 0.796 [95% confidence interval (95% CI) 0.736–0.856]. Over the next 12 months (single use period), out of 124 patients continuing to receive hemodialysis, 10.5% (n = 13) patients died, 89.5% (n = 111) patients survived (5 patients Tx). A total of 53.8% (n = 7) of these deceased patients died from CVD. The survival rate at the second year (single use period) was S(t) = 0.894 [95% CI 0.839–0.948]. CONCLUSION Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions, leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival of 12.3%.

MO537: Effects of COVID-19 on Mineral and Bone Disease Outcomes in Hemodialysis Patients: A Retrospective Study From Qatar

BACKGROUND AND AIMSManagement of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar.METHODA retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (>1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019–September 2021).RESULTSWe included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March–June 2020) then dropped afterward briefly for 3 months (October–December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February–May 2021) but then dropped again for 3 months (July–September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77–83%) and 76% (74–79%), respectively].CONCLUSIONOur retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic.

175 The Unfinished Journey towards Transplant Equity: an analysis of racial/ethnic disparities for children in the post-KAS era

OBJECTIVES/GOALS: Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We aimed to assess the impact of recent systemic changes on these disparities. METHODS/STUDY POPULATION: Retrospective cohort study of pediatric patients utilizing data from the United States Renal Data System (USRDS) and Scientific Registry of Transplant Recipients (SRTR). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) using Cox proportional hazards in the 4 years preceding KAS to the 4 years post-KAS implementation. RESULTS/ANTICIPATED RESULTS: Compared to the pre-KAS era, patients post-KAS were more likely to be pre-emptively listed (26.8% vs 38.1%, p<0.001) and pre-emptively transplanted (23.8% vs 28.0%, p<0.001), however these benefits were not uniform across racial groups. Only 12.7% and 15.7% of Black and Hispanic children received a pre-emptive transplant compared to 29.6%, 49.8% and 54.4% of White, Asian and Other race children respectively. Compared to White children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service aHR 0.67 (0.59-0.76) and 0.82 (0.73-0.92), in the post-KAS era. Time to DDKT after listing was comparable across all racial groups in both eras. Black children have disproportionally worse 5-yr ACGF, aHR 1.50 (1.08-2.09), p=0.02. DISCUSSION/SIGNIFICANCE: After KAS implementation there remains equity in time to DDKT, however disparities persist in transplant listing and ACGF among Black children. Further studies are needed to identify granular SES factors impacting delayed referral and systemic barriers to transplant, as well as risk factors for poor allograft outcomes among minority children.

Chronic kidney disease in Ecuador: An epidemiological and health system analysis of an emerging public health crisis.

The absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of CKD along with increasing diabetes, hypertension and population age. From 2012, augmented funding for renal replacement therapy expanded dialysis clinics and patient coverage. We conducted 73 in-depth sociological interviews with healthcare providers in eight provinces and collected quantitative epidemiological data on patients with CKD diagnoses from six national-level databases between 2015 and 2018. Datasets show a total of 17,484 dialysis patients in 2018, or 567 patients per million population (pmp), with an annual cost exceeding 11% of Ecuador’s public health budget. Each year, there were 139–162 pmp new dialysis patients, while doctors reported waiting lists. The number of patients on peritoneal dialysis was static; those on hemodialysis increased over time. Only 13 of 24 provinces were found to have dialysis services, and nephrologists were clustered in major cities, which limits access, delays medical attention, and adds a travel burden on patients. Prevention and screening programs are scarce, while hospitalization is an important reality for CKD patients. CKD is an emerging public health crisis that has increased dramatically over the last decade in Ecuador and is expected to continue, making coverage for all patients impossible and the current structure, unsustainable. A patient registry would help health policymakers and administrators estimate the demand and progression of patients with consideration for comorbidities, disease stage, requirements and costs, mortality and follow-up. This should be used to help identify where to focus prevention and improved treatment efforts. Organized monitoring of CKD patients would benefit from improvements in patient referral. Community-based education and prevention programs, the strengthening of primary healthcare capacity (including basic routine tests) and improved nephrology services are also urgently needed.

PERLINDUNGAN HUKUM TERHADAP PENYELENGGARA PELAYANAN KESEHATAN HEMODIALISA DI RUMAH SAKIT

To ensure legal protection for hemodialysis service providers, both for hospitals as service providers, medical personnel and health workers as service providers, the Government has stipulated Minister of Health Regulation Number 812/Menkes/PER/VII/2010 concerning the Implementation of Dialysis Services in Service Facilities. Health. As long as doctors or health workers in carrying out their duties in providing hemodialysis health services to patients are still guided by professional standards, medical service standards and standard operating procedures, legal protection for the practice of these services is a right guaranteed by law. Furthermore, there are 3 (three) pillars so that doctors and health workers become professionals, namely obeying the law, discipline, and ethics. To ensure the implementation of quality hemodialysis services and provide legal protection for each hemodialysis service provider. Keywords: Hemodialysis; Legal Protection; Service Provider.

Dialysis attendance patterns and health care utilisation of Aboriginal patients attending dialysis services in urban, rural and remote locations

BackgroundAboriginal people in the Northern Territory (NT) suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. As there are few dialysis services in remote areas, many Aboriginal people are required to relocate often permanently, to access treatment. Missing dialysis treatments is not uncommon amongst Aboriginal patients but the relationship between location of dialysis service and dialysis attendance (and subsequent hospital use) has not been explored to date.AimTo examine the relationships between location of dialysis service, dialysis attendance patterns and downstream health service use (overnight hospital admissions, emergency department presentations) among Aboriginal patients in the NT.MethodsUsing linked hospital and dialysis registry datasets we analysed health service activity for 896 Aboriginal maintenance dialysis patients in the NT between 2008 and 2014. Multivariate linear regression and negative binomial regression analyses explored the associations between dialysis location, dialysis attendance and health service use.ResultsWe found missing two or more dialysis treatments per month was more likely for Aboriginal people attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. However, we found higher dialysis attendance and lower health service utilisation for those receiving care in rural and remote settings. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, among Aboriginal people from remote areas, those dialysing in remote areas had lower rates of hospitalisations (IRR 0.56; P < 0.001) when compared to those who relocated and dialysed in urban areas.ConclusionThere is a clear relationship between the provision and uptake of dialysis services in urban, rural and remote areas in the NT and subsequent broader health service utilisation. Our study suggests that the low dialysis attendance associated with relocation and care in urban models for Aboriginal people can potentially be ameliorated by access to rural and remote models and this warrants a rethinking of service delivery policy. If providers are to deliver effective and equitable services, the full range of intended and unintended consequences of a dialysis location should be incorporated into planning decisions.

Improving management of needle distress during the journey to dialysis through psychological education and training\u2014the INJECT study feasibility pilot protocol

BackgroundNeedle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention—an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses.MethodsThis investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes.ConclusionThe results will inform the protocol for larger trials addressing needle distress in HD patients.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/.

Accessibility and quality of haemodialysis services in an urban setting in South India: a qualitative multiperspective study

ObjectiveTo explore the accessibility and quality of existing haemodialysis services in an urban setting.SettingThe study was conducted in Bangalore city, India.ParticipantsA total of 28 stakeholders including 2 nephrologists, 7 duty...

POS-572 OUTSOURCING OF DIALYSIS SERVICES: IMPLEMENTATION AND CHALLENGES

Outsourcing of dialysis services is a new practice in Gulf region. The objective is to understand and analyze the implementation, functioning and effectiveness of outsourcing dialysis program on the achievement of clinical performance indicators and quality standards. It is also draws on the management structure and challenges encountered.

POS-886 ASSESSMENT AND COMPARISON OF FIRST AND SECOND WAVE BIOMEDICAL WASTE GENERATION IN DIALYSIS UNIT IN COVID 19 PANDEMIC

Coronavirus disease 2019(COVID19), which is caused by severe acute respiratory syndrome coronavirus2 (SARS-COv-2), primarily manifests as an acute respiratory illness but it can affect multiple organs including kidney. Our world dialysis service, based on ~2 kg of waste from each dialysis treatment, would generate ~625,000 tones of plastic waste, waste that would be potentially reusable if simple sterilizing techniques were applied to it at the point of generation. The waste stream in the HD unit basically consists of: Clinical Waste Bags, Domestic Waste Bags, Sharps Bins Boxes, Fluid Wastes

The Relationship Between Dialysis Symptoms and Psychiatric Symptoms in Individuals Receiving Hemodialysis Treatment

Purpose: This study was carried out descriptively in order to determine the effect of hemodialysis symptoms on psychiatric symptoms in individuals with hemodialysis (HD) treatment. Material and Methods: The research was conducted with 104 patients who were scanned in the dialysis service of a public hospital. Personal Information Form, Dialysis Symptom Index (DSI), Brief Symptom Inventory (BSI) were used for data acquisition. The data were analyzed via IBM SPSS 22 software. Results: Patients mean DSI score (63.086±22.65), BSI total score (57.115±27.67), BSI subscale scores Anxiety (10.903±7.84), Depression (19.452±9.86), Negative self (8.990±6.40), Somatization (10.144±5.44) was found as hostility (7.625±4.32). A positive and significant correlation was determined between the patients DSI score and BSI total score and their subscales Anxiety, Depression, Negative Self, Somatization and Hostility (p<0.05). Conclusion: As a result of the study, it was determined that as the dialysis symptoms of individuals receiving HD treatment increased, their psychiatric symptoms increased. The nurse can contribute to the development of the patient's coping skills by evaluating the physiological and psychiatric symptoms of the disease and making plans accordingly.

Impact of COVID-19 on dialysis patients: Reported experience in Qatar

Background: Patient-centered care is a concept focussing on meeting the specific health needs of patients as expressed by them. Patients Reported Experience Measures (PREM) is another concept associated with patient-centered care. PREM surveys capture information about the healthcare experience as perceived by patients.1 Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution.2 Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit. In 2020, the COVID-19 impacted dialysis services and resulted in many challenges including staff shortage and deployment. Yet, the patients’ feedback was evaluated continuously and compared with previous years before the pandemic. Methods: A validated questionnaire from the National Health Service in London was used.3 It consisted of 7 questions covering demographics, dialysis options, patient portal, patient&apos;s relationship with the staff, teamwork, and traveling abroad. The survey involved 317 randomly selected patients who have been at least one year on dialysis. A comparison between 2019 and 2020 results was conducted using the chi-square test. Results: A drop in patients’ experience was observed in many survey components like education on dialysis, medication side effects, access to the patient portal, access to physicians and nurses from home (Figure 2). However, in other areas, some positive experiences remained unchanged like communication and knowledge among the staff.:Conclusion: Patients’ reported experience helps in the evaluation of health services. After exploring dialysis patients’ experiences, it was possible to identify what is going well and how COVID-19 impacted the patients’ perspectives. The PREM survey conducted in this work showed a significant decline in many parameters likely attributed to COVID-19 consequences including the staff shortages.

Challenges to improve the Coronavirus disease 2019 (COVID-19) Immunization among dialysis population in Hamad General Hospital in the Nephrology Division, Hamad Medical Corporation, Doha, State of Qatar

Background: Hamad General Hospital (HGH) Nephrology Department is the main provider for dialysis services in Qatar, serving almost 900 patients. The introduction of the COVID-19 vaccination is a crucial step in protecting End Stage Renal Disease (ESRD) patients who are vulnerable and prone to infections due to their immunocompromised status.1 They are at high risk because they are unable to practice adequate safe physical distancing as the majority of them are dependent on others due to age and the medical condition. During the first wave of the COVID 19 pandemic, the mortality rate was 20-30% among the dialysis population.2 Several challenges were faced since February 2020 to manage and control COVID-19 infection in dialysis units. Vaccination is the most important preventive measure in facing COVID-19. Hence, a multidisciplinary team was formulated in March 2020 aiming to raise the patients and staff awareness of the importance of COVID-19 vaccination. Methods: The assessment of dialysis patients’ knowledge and educational needs was done by conducting multidisciplinary focus group activities, providing educational materials in many languages, education through hospital TV channels, WhatsApp group activities with patient educators, and direct education during physicians’ monthly dialysis assessment. Monitoring the compliance rate was done by monthly data collection and targeting non-compliant groups. Results: After the implementation of COVID-19 immunization strategic plan by the end of June 2021, 75% (666 patients) out of 884 dialysis patients were vaccinated (Figure 1). The current vaccination update for over 16-year-old in Qatar is 62.8% 3. Moreover, COVID-19 positive patients were properly managed since the beginning of 2020 by following Ministry of Public Health (MOPH) guidelines to control the spread among the dialysis population and the successful initiation of COVID-19 vaccination program (Figure 2). Conclusion: Continuous educational activities and awareness campaigns have increased COVID-19 immunization percentage among the dialysis population and probably contributed to saving lives.

The COVID-19 pandemic and access to health care in people with chronic kidney disease: A systematic review and meta-analysis.

This systematic review aims to evaluate the effect of the COVID-19 pandemic on access to health care for patients with CKD. MEDLINE and EMBASE databases were searched up to July 2021 (PROSPERO CRD42021230831). Data relevant to access to health care before and during the COVID-19 pandemic were extracted, including outcomes related to access to general nephrology consultations, telehealth, dialysis services and kidney transplantations. Relative and absolute effects were pooled using a random effects model to account for between-study heterogeneity. Risk of bias was assessed using a modified Quality in Prognostic Studies tool. The certainty of the evidence was rated using the GRADE approach. Twenty-three studies across five WHO regions were identified. Reductions in transplantation surgeries were observed during the COVID-19 pandemic compared with the pre-COVID-19 era (risk ratio=2.15, 95%CI=1.51-3.06, I2 = 90%, p< .001). Additionally, six studies reported increased use of telehealth services compared with pre-COVID-19 times. Four studies found reduced access to in-person general nephrology services and six studies reported interruptions to dialysis services during the COVID-19 pandemic. Our findings suggest COVID-19 pandemic may have led to reductions in access to kidney transplantation, dialysis and in-person nephrology care. Meanwhile, whilst the use of telehealth has emerged as a promising alternate mode of health care delivery, its utility during the pandemic warrants further investigation. This study has highlighted major barriers to accessing care in a highly vulnerable chronic disease group.

Monitoring the quality of the water used in mobile dialysis services in intensive care units in the city of Rio de Janeiro.

Introduction:Monitoring water quality in mobile dialysis (MD) services, assessing critical points and characterizing the risks inherent in the process, is essential to avoid risks to the patient's health. This study evaluated the microbiological quality of water in the MD of 36 hospitals with intensive treatment in the city of Rio de Janeiro.Methods:204 water samples were collected from the points of entry to the network (NET), post-osmosis (PO) and dialysis solution (DS). The samples were evaluated for heterotrophic bacteria count, pathogen search, presence of endotoxins and aluminum content.Results:Bacterial contamination at 3 collection points in 36 hospitals was 30% (32/108); 42% from DS, 31% from PO and 17% from NET, with the presence of Pseudomonas aeruginosa, Stenotrophomonas maltophilia , Burkholderia cepacia and Ralstonia pickettii in the 3 points. Endotoxin concentrations above 0.25 EU/mL occurred in 77% of the samples (17/22) analyzed in the PO. In the aluminum content, values above 0.01 mg/L were presented in 47% (7/15) of PO samples and 27% (4/15) of NET samples. There is no specific legislation for water used in the MD; therefore, the limits of the RDC of the National Health Surveillance Agency (Anvisa) 11/2014 were used; which regulates conventional hemodialysis services.Conclusion: The results highlight the importance of evaluating water quality in MD services to ensure patient safety and support the sanitary monitoring of this process as a healthcare promoter.

Clinico-Epidemiological Profile of Dialysis Services in Karnataka, India - A Multicentric Exploratory Study.

Introduction:New challenges in dialysis care delivery confront caregivers with the rise in dialysis numbers. There are significant lacunae in the knowledge and efficient application of dialysis therapy in the absence of a dialysis registry. This multicentric study was conducted by the Nephrology Association of Karnataka to systematically study patient demographics and dialysis characteristics in Karnataka state, India, as a basis for a statewide dialysis registry.Material and Methods:Data were collected from the consenting dialysis centers after institutional ethics board clearances. Residents of Karnataka state, who were confirmed prevalent patients with end-stage renal disease, on either maintenance hemodialysis (HD) or peritoneal dialysis were included. Demographic data of patients and details of dialysis as well as dialysis facilities were collected on an online platform. Statistical analysis was done using SPSS software Version 16.Results:Thirty-two centers contributed to the data of 2,050 patients (males 70.3%, mean age 53.49 ± 14.09 years). Most patients were on HD (95.3%). Diabetes was the commonest cause of chronic kidney disease. About 72% of patients had temporary venous catheters as initial vascular access. In all, 1,156 patients (59.9%) were on thrice weekly HD. Around 65% of the centers were in private hospitals. The majority (90%) of the centers reused dialyzers, 56% reprocessed dialyzers mechanically, and 66% tested viral serology quarterly.Conclusions:This study was one of the initial attempts to capture dialysis data across Karnataka, and it offers useful insight into the existing dialysis demographics and care delivery. Participation of more centers and continued effort to form a dialysis registry for deriving meaningful clinico-epidemiological insight are desirable.

Analiza organizacije rada dijaliznih centara tokom epidemije COVID-19 infekcije u Srbiji

Monitoring and assessment of the implementation of the National Program of Prevention, Treatment, Advancement and Control of Renal Insufficiency and Dialysis Development in the Republic of Serbia by 2020 has been implemented by the Institute of Public Health of Serbia "Dr Milan Jovanović Batut". As the mode of dialysis centres operation changed after the COVID-19 epidemic was proclaimed, whereby some centres started operating in the Covid-regime, while Covid-negative patients from these centres were rerouted to the closest dialysis centres with available capacities, the need for monitoring and assessing the conditions for the implementation of the chronic dialysis program was further emphasized. The purpose of this paper is to provide a retrospective analysis of the conditions for the implementation of a chronic dialysis program in healthcare institutions within, and outside of the Network Plan during the COVID-19 outbreak in the period from the beginning of the epidemic to 1 October 2021. For the purposes of this study, a special questionnaire was designed, which was filled in by dialysis centres. The questionnaire consisted of three parts pertaining to: a) implementation of infection prevention measures at the dialysis centre, b) availability of personal protection equipment and disinfectants at the dialysis centres during the COVID-19 pandemic and c) conditions for the provision of dialysis services to patients positive for, or suspected of, COVID-19 infection. In the observed period, as much as 39% of the dialysis centres were designated to receive patients from other healthcare institutions, which called for additional efforts in organising and pursuing transmission containment. Implementation of transmission prevention measures in the dialysis centres was maintained at a very high level (between 95.5 and 100%). Only 10-15% of dialysis centres reported occasional shortages of individual items from the personal protective equipment or disinfectant categories. Almost one in five dialysis centres received a higher number of patients during the outbreak than was the case in the pre-pandemic period. In that sense, it was difficult to maintain the necessary physical distance in an already limited space, and to organize work in shifts as human resources were restricted. In addition to the general documents pertaining to infectious disease transmission prevention and containment, a protocol needed to be elaborated to organize the operation of dialysis centres in an outbreak such as the one caused by the SARS-CoV-2 virus.

Quality of Life in Chronic Kidney Disease Patients on Dialysis at the University Teaching Hospital-Adult Hospital, Lusaka, Zambia

Introduction: The importance of determining health related quality of life in Chronic Kidney Disease patients on dialysis is well established. However, research was limited in establishing the health related quality of life for chronic kidney disease patients on dialysis at University Teaching Hospital-Adult Hospital. Further the effects of haemoglobin levels and adequacy of dialysis on their health related quality of life were unknown. Therefore, the study sought to answer a research question: what is the health-related Quality of Life for Chronic Kidney Disease patients on dialysis at University Teaching Hospital? Method: The study was an analytical cross-sectional study that used a census sampling method. The study participants comprised of 104 patients who sought dialysis services (2020-2021) from the University Teaching Hospital-Renal Unit in Lusaka, Zambia. A structured Kidney Disease Quality of Life Short form (KDQOL-SF 36) was used to collect data. The Data was analyzed using the Statistics and Data software version 13, Chi-square tests, and logistic regression analysis was employed to analyse the data. A confidence interval of 95% was set with a significant level of 0.05. Results: The study included 104 Chronic Kidney Disease patients from the Dialysis Unit at University Teaching Hospital in Lusaka, Zambia. Two-thirds (68%) of the patients had a good overall health-related quality of life with the biological wellbeing having exceptionally high scores. The male gender (66.7%), unemployment (69.4%), and low haemoglobin levels (77.8%) were identified as factors associated with poor health-related quality of life. Conclusion: The health related quality of life of Chronic Kidney Disease patients at University Teaching Hospital was good. Low haemoglobin levels, age, male sex and unemployment were found to be factors associated with poor health related quality of life. Integration of health-related quality of life assessment for Chronic Kidney disease patients on dialysis in routine care is paramount. Particular focus should be on patients presenting with low haemoglobin levels, age, male sex and unemployment for timely interventions.

Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019.

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

Patients’ Perspectives on Access to Dialysis and Kidney Transplantation in Rural Communities in Australia

IntroductionThis study aimed to describe the perspectives of patients from rural communities on access to all forms of kidney replacement therapy to inform strategies to address such inequity.MethodsSemistructured interviews were conducted. Transcripts were thematically analyzed.ResultsThere were 28 participants, of whom, 14 (50%) were female and 5 (17%) Aboriginal or Torres Strait Islander. The mean distance to a nephrologist was 107 km, and transplant center was 447 km. We identified the following 5 themes: encumbered by transportation hardship (burdening of family and friends, frustration at lack of transportation options, heightened vulnerability to road trauma, unrelenting financial strain); deprived of treatment and care (isolated from centralized services, unresolved psychological distress, vulnerable without care, disadvantaged by limited options); confused by multiple information sources (despair at fragmented care, fear of unfamiliar health settings and treatments); compounding economic consequences (depletion of income/leave, coping with unexpected expenses); and the looming threat of relocation (devastated by displacement, resigned to periods of separation, uncertainty in sourcing appropriate accommodation).ConclusionPatients with chronic kidney disease (CKD) in rural communities face profound economic, logistical, and psychological obstacles to accessing dialysis and transplant, leaving them feeling vulnerable and confused. To achieve equity of access and improved health outcomes for rural patients with CKD, barriers to dialysis, transplantation, and psychological services in this population require addressing through policy and alternate models of health service delivery, in consultation with rural communities and those families affected by CKD.