Dialysis Staff Research Articles

Experience of Continuous Ambulatory Peritoneal Dialysis In Remote Area of Southeast Bangladesh

Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds area. J Dhaka Med Coll. 2023; 32(1) : 24-31

8675 Dosing of Radioactive Iodine for Papillary Thyroid Cancer in Advanced Chronic Kidney Disease

Abstract Disclosure: C. Cheatham: None. D. Beckman: None. INTRO Radioactive Iodine (RAI) ablation is an important treatment for patients diagnosed with papillary thyroid carcinoma. Most studies completed on RAI in renal dysfunction were focused on End Stage Renal Disease (ESRD) patients on dialysis to establish protocols on timing of dialysis to allow desired clinical response to RAI without increased risks and minimizing exposure of dialysis staff to radiation dose. The ideal RAI dosing and monitoring of patients with advanced chronic kidney disease (CKD) stage 4 or 5 not requiring dialysis has not been systematically reviewed. CASE 26 year-old female with CKD stage 4/5 secondary to chronic hydronephrosis from vesicoureteral reflux with baseline eGFR 15-20 mL/min/1.73 m2 was diagnosed with papillary thyroid cancer. She underwent total thyroidectomy with central and left lateral neck dissection, resulting in pathologic stage I, pT2 N1b M0 disease, high risk for recurrence according to the 2015 American Thyroid Association guidelines due to 17 positive lymph nodes from left level II-IV and VI, multiple with extranodal extension, as well as 1 vessel angioinvasion. She was referred for adjuvant RAI ablation after withdrawal from thyroid hormone. Decision was made to proceed with a 50% dose reduction and close monitoring of radioactivity clearance as an inpatient given decrease of eGFR to 10-12 mL/min/1.73 m2. She was cleared for discharge 4 days after RAI dose of 74.8mCi when activity level dropped to <2mR/hr. Post-ablation whole body scan showed activity in the thyroid bed and parasternal notch without evidence of metastatic disease. Post-treatment non-stimulated thyroglobulin 6 weeks later was 0.4 ng/mL down from 269.7 ng/mL. DISCUSSION Given RAI is predominately renally cleared, decreased renal function affects clearance rates and associated exposure to radiation. Risks with decreased RAI clearance include bone marrow toxicity and prolonged isolation requirements. In a 2017 retrospective review, patients with eGFR <30 mL/min/1.73 m2 had delayed clearance leading to a mean proportional reduction of exposure rate at 48 hours of -67.2% compared to -94.3% in healthy controls. While protocols exist for patients on hemodialysis, no such protocols have been established for patients with advanced CKD not requiring dialysis. For this patient, after multidisciplinary discussion with nuclear medicine, health physics, and nephrology in setting of further eGFR reduction during hormone withdrawal, decision was made to reduce the intended dose by 50% with inpatient monitoring and backup to dialyze if no significant decrease in radiation activity level was seen or if she were to progress to anuric or oliguric renal failure. This case highlights the need for established protocols and long-term studies to evaluate risk and treatment response in relation to dosing of RAI in this population, but a 50% dose reduction appears to be effective without adverse event. Presentation: 6/2/2024

Impact of pruritus in patients undergoing hemodialysis in Italy: a patient-based survey

BackgroundItching is an annoying symptom which afflicts patients with chronic renal failure. We aimed to assess the impact and patient’s perception and experience of itching in the dialysis population in Italy.MethodsA questionnaire was developed by the National Hemodialysis and Dialysis Association of Italy (ANED) and administered to 996 hemodialysis recipients across 153 Italian dialysis centers. The main outcomes investigated by the questionnaire were patients’ satisfaction on answers regarding the nature of itching; continuing to talk about itching with the nephrologist; beliefs about resolution of itching.ResultsA total of 1903 patients from 153 centers responded to the questionnaire. Patients who responded had a mean age of 67.9 ± 13.8 years (63.9% male) and were stratified by itch discomfort graded as mild (35.9%), moderate (29.6%), and severe (34.4%). Severe itching disrupted patients' daily lives, strained their relationships, caused anxiety, and diminished their quality of life. Patients with severe itch were more likely to talk about it with dialysis staff and to undertake dermatological visits. However, only 18.0% of patients reporting severe itching found the clinicians' responses satisfactory, compared to 49.1% of mild itch patients. Those who continued talking to nephrologists about itching received more satisfactory response. However, 40.8% believed itching could not be alleviated and were less likely to discuss it with nephrologists.ConclusionsThere is an intricate relationship between the severity of itching, patient perceptions, and healthcare communication among hemodialysis patients. A substantial proportion of patients experiencing severe itching expressed feelings of resignation, highlighting the pressing need for enhanced clinician-patient communication.Graphical

#1600 The effect of integrated real-time hemodialysis surveillance on staff workload and time efficacy—a multicenter prospective study

Abstract Background and Aims For many years, dialysis data have been manually registered and transferred to the patients’ electronic health records by dialysis staff. However, manual documentation can be associated with poor data completeness, delayed recognition of inadequate dialysis prescriptions, and high staff workload. We studied the effect of introducing a new integrated, digitalized haemodialysis surveillance system, the Treatment Guidance System (TGS), on staff workload and time saving in clinics from a large multi-national dialysis provider. To measure the effect of introducing the new TGS system on staff workload and time saving. Method This was a prospective, observational multicenter study conducted between November 2021 and January 2023 in five countries: Saudi Arabia, Spain, Portugal, UK, and Kazakhstan. Inclusion criteria were clinics with adequate digital infrastructure, introducing the TGS. Only staff without prior experience with TGS were included in this study. Staff workload was determined using the NASA Task Load Index (TLS) at three timepoints: 1: two weeks prior to introduction of the TGS, 2: one month after introduction of the TGS, and 3: three months after introduction of the TGS. Time saving was determined by observation of the time used for dialysis data documentation by an independent person at timepoints 1 and 3. Differences in staff workload were determined by Friedman's two-way analysis of variance by ranks with Bonferroni correction for multiple tests, while time saving was determined by Wilcox signed rank test. Results In total, 223 participants from 20 clinics were included in the study, 56% were female, age distribution was 32.1% <30 years, 58.8% 30-49 years, and 9.1% ≥50 years, and dialysis experience was 17.5% ≤2 years, 27.9% 2-5 years, 33.3% 5-10 years, and 21.2% >10 years. The staff adaptability to the introduction of TGS at their workplace and the workload perception improved significantly over all domains of the NASA TLS (Table 1). While most domains improved by approximately 50%, median physical demand improved by more than 60% (Table 1). There was some variation of the observed time used for documentation between different countries, however, the observed time decreased in all countries from median (25-75%) 9:35 (5:36-14:41) minutes at timepoint 1 to 5:22 (2:05-9:22) minutes at timepoint 3 (p < 0.001). The largest saving was noted in the United Kingdom (14:06 (11:01-18:25) to 5:17 (4:56-5:45) minutes), while the smallest saving was noted in Kazakhstan, where only 3 individuals were observed (3:37 to 3:08). Conclusion Introduction of the novel, digitalized, integrated real-time dialysis documentation system TGS greatly reduced staff workload and time spent with documentation of dialysis treatments. Digitalization and automation of haemodialysis treatment has the potential to improve dialysis treatment, which will be further elucidated by the analysis of data quality and completeness in the current study.

#1705 Central delivery of acid concentrate for haemodialysis: a single-center experience

Abstract Background and Aims Dialysate is produced by mixing ultra-purified water with acid and bicarbonate concentrates. Acidic concentrate for hemodialysis can be supplied to the dialysis machine through single-use bags or central concentrate supply. Central delivery of acid concentrate represents an innovation in hemodialysis settings in terms of practicality and eco-sustainability as this system is able to produce and distribute ready-to-use acid dialysis concentrate without the use of acid concentrate bags. The aim of our study was to compare the amount of material (including packaging) used to supply acid concentrate using a single-use bag (3.8 L or 4.5 L) or central acid supply at the Nephrology Dialysis and Renal Transplant Unit of Azienda Ospedaliero Universitaria di Modena, Modena, Italy. In particular, we reviewed the amount of consumable material before (January-December 2019) and after the implementation of central concentrate supply (July 2022-June 2023). Lastly, a survey was delivered to all dialysis nurses who work in our dialysis Center to evaluate their feedback on central concentrate supply. Method Our center is equipped with 46 dialysis stations for patients on chronic hemodialysis that in 2019 delivered 30 000 hemodialysis treatments distributed across morning, afternoon, and evening shifts. Granumix system® (Fresenius Medical Care, Bad Homburg, Germany) was installed in 2022. It produces and distributes acid concentrate fluid with two different concentrations of K+ (2 and 3 mEq/L) and a unique concentration of Ca2+ 1.5 mmol/L (see Figure). Results The data collected in 2019 at our Dialysis Center showed that 30 000 acid bags corresponding to 121 000 L of acid concentrate fluid were used to perform hemodialysis. Utilization of bags generated 3 750 kg of pallets, 4 500 kg of plastic and 5 367 kg of boxes. Considering that approximately 10% of the acid concentrate fluid remains unused during each dialysis treatment, approximately 12 000 L of unutilized acid concentrate fluid was wasted. Following the introduction of the Granumix® system, there was a significant reduction (−80.6%) in the utilization of single-use acid concentrate bags (n = 5 805) and, consequently, in the use of boxes (n = 2 294 vs. n = 11 667) and pallets (n = 40 vs. n = 208). The centralized distribution system of acid concentrate led to a significant reduction in waste including boxed, plastic and pallets (2 642 kg vs. 13 617 kg), disposal of residual acidic solution (2 351 liters vs. 12 100 liters), and handling of materials by dialysis staff (37 522 kg vs. 158 117 kg). Another advantage of this system is the optimized usage of acid concentrate fluid. This system ensures that only the required amount of acid for a specific treatment is used, effectively minimizing waste and decreasing the production of special waste. The results of the survey (response rate 75%) documented that 79.5% of the nurses received adequate training for its use; 94.9% experienced a reduction in fatigue and 84.6% declared that had more time to dedicate to patients. Lastly, the survey showed that 96.4% of the participants were completely satisfied with the implementation of this new system. Conclusion Central delivery of acid concentrate is an innovative solution with eco-sustainable potentialities in reducing the consumable materials and workload in hemodialysis. Overall, most nurses expressed satisfaction as this system reduces dialysis staff workload and allows more time for patient care.

#2155 Evaluating the health-related quality of life of patients undergoing haemodialysis: highlights from a multicentric nationwide study

Abstract Background and Aims Haemodialysis (HD) represents the most common renal replacement therapy for end-stage renal disease worldwide. Despite recent advances in HD the health-related quality of life (HRQoL) should be monitored in conjunction with clinical variables to optimize a comprehensive treatment. Method From June to July 2022, all patients from 47 clinics were included. Among other key relevant clinical variables, HRQoL was assessed by using the Kidney Disease Quality of Life Short Form (KDQOL-SF™ 1.3).It`s generic part is summarised in the physical component summary (PCS) and mental component summary (MCS). The specific part evaluates 11 domains: symptom/problem list; effects of kidney disease on daily life; burden of kidney disease; work status; cognitive function; quality of social interactions; sexual function; sleep; social support; dialysis staff encouragement; and patient satisfaction. All scores range from 0 (worst) to 100 (best). To ensure comparability of results, mean ± SD values are outlined, even though non-parametric tests were used to test associations. Results A total of 3,595 patients (67.3% male) completed the KDQOL (out of 4259 HD patients treated during study period). Most of them (67.18%) were over 60yo of age, and 65.67% had a severe comorbidity index score. In addition, 50.54% had a native AV fistula and only 3.92% were incident HD. PCS scores reported were higher in over 75yo (47.68 ± 10.63) rather than normative population (40.16 ± 11.62), indicating an overall good physical function. However, MCS values (33.17 ± 9.36) were indicative of substantial impact. Gender differences were noted across almost all disease-specific and generic domains (all p < 0.05). Severe comorbidity scores were associated with lower scores in certain renal specific domains and MCS. Finally, incident HD patients reported lower satisfaction and poorer perceived overall health (p-values = 0.001). Conclusion Although PCS scores reported were reasonable, a remarkable impact on mental health was found. Moreover, a differential impact of patient's HRQoL was captured based on gender and other variables highlighting the need of individualised evaluation and management of HD patients.

The influence of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life of patients with sarcopenia receiving haemodialysis: a randomised controlled trial

ObjectiveTo study the effect of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life in patients with sarcopenia receiving maintenance haemodialysis (MHD).MethodsEligible patients with sarcopenia in our hospital were randomly assigned to a control group (n = 24) and an intervention group (n = 25). The control group received conventional dialysis treatment, while the intervention group underwent mindfulness meditation combined with progressive muscle relaxation training during the interdialysis period in addition to conventional dialysis treatment. The effect of the intervention was evaluated after 12 weeks.ResultsThere were no significant differences in the baseline values of various parameters between the two groups. Exercise capacity (sit-to-stand test,handgrip,time to 10 sit-ups) significantly improved in the intervention group after 12 weeks (32.68 ± 8.32 vs 26.50 ± 6.83; 37.42 ± 10.12 vs 28.12 ± 8.51; 19.8 ± 5.40 vs 25.29 ± 7.18) (p < 0.05). In terms of the kidney disease quality of life (KDQOLTM) score, all other dimensions except sexual function, social functioning, burden of kidney disease and work status dimensions showed significant improvement compared to the baseline (p < 0.05). In the control group, only the dialysis staff encouragement (DSE) and patient satisfaction (PS) dimensions showed slight improvements compared to the baseline (p > 0.05). When compared with the control group, the intervention group showed significant improvements in 10 dimensions of exercise capacity and KDQOLTM scores for physical function, role-physical, general health, energy, symptom/problem list, sleep, DSE, pain, cognitive function, emotional well-being and patient PS after 12 weeks (61.30 ± 5.38 vs 42.98 ± 5.73; 57.50 ± 3.55 vs 50.70 ± 3.62) (p < 0.05). Some inflammatory markers, such as the levels of interleukin-6 and high-sensitivity C-reactive protein (30.29 ± 2.96 vs 17.65 ± 3.22; 8.93 ± 0.99 vs 3.02 ± 0.34), showed a decrease during the intervention, while albumin and prealbumin levels were significantly increased compared with the baseline (30.62 ± 1.65 vs 35.60 ± 1.68; 0.32 ± 0.05 vs 0.44 ± 0.07) (p < 0.05).ConclusionCombined intervention training can improve the motor ability and quality of life of patients with sarcopenia within a short period of time.

Indications and Complications of Emergency Hemodialysis Among Patients with Acute Kidney Injury Admitted in Hemodialysis Center at Bahri Teaching Hospital, Khartoum State, Sudan 2021 - 2022

BACKGROUND: AKI is defined as abrupt decline in renal functions either due to structural damage or loss of function , associated with poor clinical outcomes for hospitalized patients. In the context of Sudan, highlighting the most common indications and complications that may occur during emergency hemodialysis and describing their presentation , may offer measures to minimize them by provide specific interventions to prevent the consequences when such emergencies arise. AIMS: To study the indications, and complications of emergency haemodialysis among patients admitted in haemodialysis center at Bahry teaching hospital, Khartoum state, Sudan . The study also aimed to describes the pattern of presentation in term of symptoms and signs reported among patients. METHODS: It’s an observational descriptive cross sectional, hospital based study that was conducted at the renal haemodialysis center within the period from September 2021 to October 2022 and covered 149 patients with AKI who underwent emergency hemodialysis,this sample size was calculated using Epi calculator and then adjusted using the hospital records that described the frequency of admission of patients with AKI in the preceding 6 months and excluded obstetric AKI . Data was collected, prepared, entered and analyzed using SPSS version 25.0 in term of descriptive statistics and Bi-variable analysis to determine the associations between some relevant factors (demographic characteristics, indications and complications) with the occurrence of complications using Chi square test (for categorical variables) and t-test (quantitative variables). RESULTS: This study covered 149 participants. Nearly half of them 40.9% of the study participants were in the age group 30-60 years with male: female ratio of 2.3:1 and 44 % of the participants had co morbid illnesses with diabetes , hypertension and liver disease being the most common. Regarding the history of renal disease only 4.7 % had previous history and 10% had family history of renal disease .The most common indication for emergency haemodialysis was uremia 44%, followed by fluid overload that cannot be managed by diuretics 30%,worsening sever metabolic acidosis 10% and refractory hyperkalemia 4.7 % . Complications on the other hand occurred among 20% of the patients such as hypotension 8.7%, and hypoglycaemia 8.7%. There was significant association between certain social habits like smoking , middle age group as well as past history of renal disease with the development of complications (p value = 0.01 , 0.005 and 0.05 respectively). CONCLUSION: nearly half of the study participants were in the age group 30-60 years old with male: female ratio of 2.3:1. The most common indication for emergency haemodialysis was uremic gastropathy followed by Volume overload . Complications occurred among 20% of the participants such as hypotension and hypoglycaemia. Recommendation, Training of health care provider on how to deal with patient with AKI and when to include nephrologist in management to avoid dialysis and training of dialysis staff on early recognition and management of complication.

A Prospective Observational Study to Assess Medication Adherence and Health Related Quality of Life in Chronic Kidney Disease Patients in a Tertiary Care Hospital

Chronic Kidney Disease(CKD) patients belong to the group of subjects with large burden of daily pill intake. Failure of adherence to these medications can lead to increased morbidity, mortality, cost, and burden on health care system. Therefore, good medication adherence is important to obtain desired therapeutic outcome which in turn improves the quality of life.&#x0D; The objective of this study is to assess medication adherence and health related quality of life in CKD patients.&#x0D; A prospective observational study was conducted for 6 months at Indiana Hospital and Heart Institute, Mangalore. Total 100 participants diagnosed with CKD were enrolled for the study. Permission from the Ethical Committee was taken and informed consent was obtained from the study subjects before initiating the study. Demographic, clinical and treatment details were collected in a specially designed data collection forms. Patient’s adherence to the medication was assessed with the help of Brief Medication Questionnaire (BMQ) and patient’s quality of life was assessed using Kidney Disease Quality of Life Short Form (KDQOL-SF). The data was expressed using descriptive statistics and analyzed using Chi square test, Mann Whitney test, and Spearman Correlation Statistics.&#x0D; Out of 100 patients enrolled in the study, 63 were male and 37 were female. The average number of medicines taken in a day by each patient was 10. 12% of the study population was completely adherent to the drug therapy. BMQ had 3 domains in which 39% of the patients were adherent and 61% were non adherent to the Regimen screen, 68% were adherent and 32% were non adherent to the Belief screen, and 31% were adherent and 69% were non adherent to the Recall screen. High cost of medicine (69%), Complex dosing schedule (68%), and Unaware about seriousness of condition or use of medicine (63%) were most common reasons for Non-adherence. Using KDQOL questionnaire, mean scores for Dialysis staff encouragement (96.25±9.31) and Quality of social interaction (87.86±17.48) were high whereas Physical role (4.75±16.92) and Emotional role (13.03±31.44) were found to be low.&#x0D; These results indicate that non adherence to medications leads to deteriorating quality of life and high therapeutic complexity.

Assessment of Health-Related Quality of Life in Chronic Kidney Disease Patients: A Hospital-Based Cross-Sectional Study.

Background: Health-related quality of life is rapidly becoming recognized as an important indicator of how a disease affects patient lives and for evaluating the quality of care, especially for chronic conditions such as chronic kidney disease (CKD). Objectives: This study is an attempt to assess the quality of life in patients with chronic kidney disease at MMIMSR and also identify characteristics that may be associated with their worsening quality of life. Materials and Methods: This cross-sectional investigation was conducted at the in-patient department (IPD) of the MMIMSR hospital. This study included 105 CKD patients and used a systematic random sampling method for quantitative analysis. This study utilized a 36-item short-form SF-36 (v1.3) questionnaire to assess HRQoL in CKD patients. Descriptive statistics were employed at the baseline. Chi square and ANOVA were used to draw comparisons between two groups or more than two groups, respectively. Logistic regression analysis was utilized to identify the potential QoL determinants. A p value of 0.05 or lower was used to determine statistical significance. Results: Among a total of 105 participants, the mean (±standard deviation) age was found to be 54.53 ± 13.47 years; 48 were male patients, and 57 were female patients. Diabetes Mellitus (61.9%), hypertension (56.2%), chronic glomerulonephritis (7.6%), chronic pyelonephritis (6.7%), and polycystic kidney disease (5.7%) were identified to be the most frequent disorders associated with CKD. The current study also demonstrated that the HRQoL score domains such as symptom problem list, the effect of kidney disease, and the burden of kidney disease decline significantly and progressively as the patient advances into higher stages of CKD (p = 0.005). A similar pattern was observed in work status, sleep, and general health (p < 0.005). Additionally, a statistically significant difference was noted for cognitive function, quality of social interaction, overall health, dialysis staff encouragement, patient satisfaction, social support, physical functioning, role of physical health, pain, emotional well-being, role of emotional health, social functioning, and energy fatigue (p < 0.005). The mean difference for PCS and MCS based on CKD stages was found to be statistically significant (p < 0.005). The PCS and MCS showed a positive correlation with GFR (r = 0.521), and Hb (r = 0.378), GFR (r = 0.836), and Hb (r = 0.488), respectively. Conclusions: The findings of this study demonstrated that a significant decrease in HRQoL was observed among CKD patients, with a progressive deterioration of HRQoL dimensions as the patient advances to end-stage renal disease. This study also revealed that CKD imposes various restrictions on patients' day-to-day lives, particularly in terms of their physical and mental functioning, even in the initial stages of the disease.

Integrating Care Coordination and Mental Health Research Into Dialysis Practice: Stakeholder Perspectives, Methods, and Outcomes

Despite many studies suggesting beneficial innovations for patients, few make it into clinical practice. This study aims to enhance patient care by facilitating effective dissemination of patient-centered outcomes research to health care workers in outpatient dialysis facilities, aided by the Patient-Centered Outcomes Research Institute's (PCORI) dissemination and implementation framework. Dissemination and implementation project. Outpatient hemodialysis facilities in the United States. We brought together panels of key stakeholders, which included researchers, patient subject matter experts, and dialysis personnel. Their role was to provide guidance on the content and methods for disseminating research findings. With a focus on 2 critical patient safety areas-care coordination or care transitions and mental or behavioral health-we developed virtual education modules. These modules were then made available to outpatient dialysis facilities by the national 5-Diamond Patient Safety Program. In 2022, the training was used by more than 2,500 dialysis facilities and approximately 40,000 dialysis staff in the care coordination module, and by more than 300 dialysis facilities and 5,000 staff for the mental health module. Cumulatively, the modules affected more than 179,000 patients. Evidence of efficacy was the significant increase in trainee knowledge of research findings and implementation considerations (P≤0.05). Potential selection bias because dialysis facilities that did not participate in the program may differ significantly from those that did, which may affect generalizability. In addition, variable timing in release of the different modules may have influenced uptake by facilities. By using key stakeholder guidance and accessible virtual education modules, the implementation framework shows promise in effectively disseminating research findings within outpatient dialysis settings. This method potentially carries implications for broader health care settings as well. Our study addresses a common health care challenge-many promising ideas for improving patient care never actually reach the patients. We aimed to bridge the dissemination gap by sharing research with health care workers in outpatient dialysis, promoting evidence-based practice. We collaborated with experts, patients, and dialysis personnel to develop easy-to-understand educational materials focused on 2 critical topics: care coordination and mental health. In 2022, our training benefited more than 2,500 facilities and 40,000 staff for care coordination, and 300 facilities with 5,000 staff for mental health, positively affecting more than 179,000 patients. We found that the training significantly increased knowledge among staff. Our approach shows promise for sharing research effectively in dialysis centers and potentially in other health care settings.

Prevalence of COVID-19 in End Stage Renal Disease Patients on Hemodialysis &amp; Dialysis Providers During SARs-Cov-19 spike in Pakistan.

The global pandemic of coronavirus disease 2019 (COVID-19) poses a significant threat to both hemodialysis staff and patients. However, the prevalence of COVID-19 among asymptomatic end-stage renal disease (ESRD) patients on chronic hemodialysis (MHD) and healthcare staff including nurses and technicians in dialysis unit remains uncertain. Given that hemodialysis patients and dialysis nurses are particularly prone in congregate settings, this research aimed to examine the prevalence of COVID-19 in two hemodialysis units at Jinnah Hospital, Lahore, Pakistan. This cross-sectional study involved the participation of 198 maintenance hemodialysis patients with end-stage renal disease (ESRD) and 83 dialysis staff members. These patients or staff members did not have any symptoms at the time of testing. Testing was conducted using qualitative reverse transcription-polymerase chain reaction (RT-PCR) on nasal &amp; pharyngeal swabs collected from June 18th to June 23rd, 2020. &#x0D; Out of the total participants, 45 out of 198 dialysis patients (22.7%) and 10 out of 83 dialysis staff members (12%) were found to be positive for COVID-19. The overall prevalence of COVID-19, combining patients and staff, was 19.5% (55 out of 281). The mortality rate among the infected patients was 6.6% (3 out of 45). To conclude, the findings of this study demonstrate a significant prevalence of SARS-CoV-2 among hemodialysis staff and patients in Lahore, Pakistan.

A Comprehensive Exercise (COMEX) Intervention to Optimize Exercise Participation for Improving Patient-Centered Outcomes and Physical Functioning in Patients Receiving Hemodialysis: Development and Pilot Testing

To address the need for an intradialytic exercise program that is easily delivered in clinical setting, engaging and scalable, we developed a novel COMprehensive EXercise (COMEX) program based on input from patients receiving hemodialysis (HD), dialysis staff members and nephrologists. The objective of this study was to determine the feasibility, safety, and acceptance of COMEX during HD. Single-arm prospective pilot feasibility study. Seventeen patients receiving in-center HD. Three-month participation in the COMEX program, which included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Data on recruitment, adherence, safety and acceptability were collected. Additional assessments were performed to evaluate changes in physical functioning, patient-reported symptoms, and objectively measured sleep and physical activity. We also examined the feasibility of obtaining skeletal muscle biopsies and blood samples to explore molecular mechanisms of muscle atrophy and to assess platelet mitochondrial function and adaptation to exercise during HD. Thirteen of the 17 (76%) participants completed the 3-month intervention. The mean participant age was 63.6±15.1 years. In total, 46% of participants were males, and 55% were White. The mean body mass index was 38.7±11.6kg/m2. There were no reported adverse effects, and the adherence rate to exercise sessions was high with 88% of the sessions completed. Patient satisfaction was high, as 100% of the patients would recommend the program to other dialysis patients. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Small sample size, lack of an onsite exercise professional, and technological issues with telemedicine behavioral motivation. The COMEX intradialytic exercise intervention is safe and acceptable to patients, and outcome measures were feasible to obtain. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol. This work is supported by pilot award from P30 DK079307 (PI, Jhamb). ClinicalTrials.gov, NCT03055299. We tested a new COMprehensive EXercise (COMEX) program to deliver exercise during dialysis. This 3-month program included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Our study shows COMEX was feasible, had high satisfaction and adherence, and was safe. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol.

Knowledge and Practices of Dialysis Unit Staff Regarding the Care and Management of Vascular Access Infections

Background: Vascular access infections among dialysis patients are becoming the major concerns that contribute to a significant morbidity and mortality across the globe. Proper management and care must be planned according to the standard protocols for the prevention of these infections. Objective: The objective of the study was to assess the knowledge and practices of dialysis staff regarding vascular access infection control in tertiary care hospitals of Peshawar, Pakistan. Methodology: A cross-sectional study was conducted on dialysis staff including nurses and technicians (n=58). All hemodialysis staff (Nurses and Technician) was included in the study who were regularly working in dialysis unit and had at least 6 months of dialysis unit experience. Data was collected through a self-administered questionnaire and checklist with its proper validation. Data was analyzed through SPSS Version-20 for its proper presentation. Results: The finding of the study showed that around 44.94% of the questions were corrected by the nurses and technician on the knowledge assessment questionnaire while looking into their practices 28.5% of the correct practices were followed by them. Additionally it was found that private sector hospital nurses and technician scored more than public sector hospitals in knowledge and practices. Practical implication: It is one of the main responsibilities of the dialysis unit staff to have knowledge regarding vascular access infections. So based on their knowledge, they will maintain the aseptic protocol while practicing, which will ensure a low infection rate and prevent the patient from complications that will improve the patient's experience and reduce the length of stay. Conclusion: It is concluded from the research findings that nurses and technician knowledge and practices are not sufficient to prevent the vascular access infections; therefore they must be trained for the provision of best possible care among the dialysis patients. Keywords: Knowledge, Practice, Vascular Access, Infections, Dialysis, Nurse, Technicians

Assessment of Quality of Life Studies of Renal Failure patients in different cities of Punjab, Pakistan

Aim: To determine the quality of life (QOL) of renal failure patients on maintenance hemodialysis on the basis of their baseline characteristics in Lahore, Pakistan. Study design: A cross sectional study was carried out with two hundred and ten patients selected randomly from dialysis centers in General, Mayo and Jinnah hospitals, Lahore Pakistan, to measure and analyze the QOL of hemodialysis patients by pre-validated KDQOL-SFTM version 1.3 in English language. Methodology: Interviews of the patients were performed to collect data. SF-36 items mean and standard deviation were performed to analyze data on the basis of gender and age groups. Results: Among the eleven scales targeting End-Stage Renal Disease (ESRD), only the "Effects of Kidney Disease" scale demonstrates a greater impact on males than females. However, three scales including Symptom/Problem list, Quality of Social Interaction, and Dialysis Staff Encouragement show suboptimal results in young patients. Similarly, two of the seven health-related outcome scales, Physical Functioning and Energy Fatigue, exhibit poor outcomes in young patients. Conclusion: Major cause of their kidney disease was hypertension and diabetes. Overall, less number of prescribed medications, decreased hospitalization and reduced hospital visits are the factors showing overall better quality of life.This study helps us understand the impacts of kidney disease on different genders and age groups, guiding the development of personalized care plans. Keywords: Quality of life (QOL), End stage renal disease ESRD, hemodialysis, KDQOL-SFTM version 1.3

#5014 VALIDATION AND APPLICABILITY OF A MONITORING SYSTEM FOR VASCULAR ACCESS IN HAEMODIALYSIS: A MULTICENTRE STUDY

Abstract Background and Aims Routine systems for monitoring vascular access (VA) performance are lacking. We recently showed that with a VA triage system it is possible to improve the average value of a number of VA efficiency parameters and that the VA triage score was associated with clinical outcomes. The triage categorization is generated monthly by a scoring system which is based on a number of parameters (blood flows, VA pressure values, end HD circuit clots and a dedicated score of the external VA examination, KT/V) recorded at each session by the staff on a dedicate electronic spreadsheet. According to threshold values, triage classified each VA in Green (G), Yellow (Y) or Red (R), thus indicating the VA performance and the clinical risk of complication linked to VA. In our open label single centre study, with three years of follow-up, the average VA score improved significantly and G VA associated with lower mortality, compared to the Y and R VA. Aims: To validate the ability of the triage system to early identify VA with increased risk of complications. Methods In this interventional prospective, blinded multicentre study, each centre used the VA triage electronic spreadsheet without knowledge of the generated triage. After six months of system implementation, two years of follow-up (01/01/2020 - 01/12/2021) were planned to record VA related events. Two external reviewers evaluated the records. A minimum of three months VA follow up was necessary for patients enrolment. Results From 18 HD centres we enrolled 757 patients, aged 64,5±15,5 y.o.; 27% diabetics; HD since 24,4±32,4 months; 369 (48,7%) with arteriovenous fistula (AVF) and 388 (51,3%) with permanent central venous catheter (CVC). During 11,4±5,6 months of follow-up (range 3-23), 108537 HD sessions were recorded on the triage electronic spreadsheet, with 214 total clinical events and an event free time of 224,5 ±172 days (range 4-713). The VA related events were 150 (70,1%) during 16,3±2,2 months of follow up (range 3-23) with an event free time of 230±160 days (range 11-713). The VA Triage was: 60% Green, 35% Yellow and 5% Red. In the 369 patients with AVF the VA Triage was: 61% Green, 36% Yellow and 3% Red; The AVF Triage Green group showed: lower incidence of VA related events respect to the AVF Triage Yellow and Red group (30% vs 48%; P: 0.05); higher time-free from VA events (AVF Green vs AVF Yellow-Red: log-rank test: 0.04). Similar results were confirmed in the CVC groups: VA events incidence Triage Green 15% vs Triage Yellow-Red 40% (p: 0.001; time-free from VA events log-rank Test 0.001). Conclusion Our VA triage system identifies 40% of vascular accesses as yellow-red triage. These VA were not identified as at elevated clinical risk by the dialysis staff and only the Triage system was able to highlight them as critical. Notably the VA access with Yellow and Red Triage independently from the VA typology had an higher risk of clinical complications that according to the time survival curve could be detectable roughly 237,8 days before the event developed. The Triage system was able to identify early the VA with increased clinical risk and it may be a useful tool to prevent VA complication.

Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis.

African Americans are more likely to develop end-stage kidney disease (ESKD) than whites and face multiple inequities regarding ESKD treatment, renal replacement therapy (RRT), and overall care. This study focused on determining gaps in participants' knowledge of their chronic kidney disease and barriers to RRT selection in an effort to identify how we can improve health care interventions and health outcomes among this population. African American participants undergoing hemodialysis were recruited from an ongoing research study of hospitalized patients at an urban Midwest academic medical center. Thirty-three patients were interviewed, and the transcribed interviews were entered into a software program. The qualitative data were coded using template analysis to analyze text and determine key themes. Medical records were used to obtain demographic and additional medical information. Three major themes emerged from the analysis: patients have limited information on ESKD causes and treatments, patients did not feel they played an active role in selecting their initial dialysis unit, and interpersonal interactions with the dialysis staff play a large role in overall unit satisfaction. Although more research is needed, this study provides information and suggestions to improve future interventions and care quality, specifically for this population.

Work Experiences of the Interdisciplinary Dialysis Workforce in the United States: A Cross-Sectional Survey

Introduction: Suboptimal dialysis care may be in part due to staff issues such as job dissatisfaction, burnout, work overload, high staff turnover, and inconsistent training. Here, we leveraged data collected in a recent national survey to provide an initial, comprehensive description of current work experiences of US dialysis care providers. Methods: We conducted a cross-sectional survey of 1,240 active US dialysis clinic staff members (physicians, advanced practice providers, nurse managers/clinic coordinators, nurses, social workers, dietitians, and patient care technicians), who were recruited via emails to society membership lists. Respondents were asked about a wide variety of work experiences, including job satisfaction, professional fulfillment, and burnout (Stanford Professional Fulfillment Index), work culture, experiences of hostility and violence, and self-reported medical errors. Responses were summarized overall and compared by clinic role. Results: Most of the survey respondents, representing all 50 US states, were aged 35–49 years (58.3%) or ≥50 years (23.5%), female (60.7%), and white (59.8%; 23.1% black, and 10.0% Asian); 82.1% had been in their current role for at least 1 year. Most US dialysis staff responding to our survey reported being generally satisfied with their jobs (mean rating of 7.9 on 0–10 scale), but only 54.4% met criteria for professional fulfillment, and 32.8% met criteria for burnout, driven by high scores in the work exhaustion domain. Related issues, including high workloads, lack of respect (including experiences of violence and hostility), lack of autonomy, and suboptimal patient environments (in terms of both safety and patient centeredness), were commonly reported among dialysis care providers, although their prevalence often differed by provider type. Conclusion: Our results suggest that the dialysis workforce may be at a critical point. Preventing further staff burnout, which could lead to even greater staffing shortages and worse working conditions among those who continue to provide dialysis care, is essential.

Quality of life of patients on Continuous Ambulatory Peritoneal Dialysis

End Stage Renal Disease (ESRD) is a serious medical disorder leading to impaired Quality oflife (QOL). QOL as perceived by patients with ESRD is an important measure of patient outcome. However, there is paucity of literature that assesses the QOL of patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) in our country. A descriptive study was undertaken to assess the QOL of patients on CAPD and to determine the relationship between QOL and selected demographic and clinical variables. A total of 33 subjects were chosen by consecutive sampling technique. Data was collected using self-administered Questionnaire - Kidney Disease Quality of life (KDQOL-SF™ 1.3) questionnaire. The mean age was 53.06+80yrs and the most common cause of ESRD was chronic disease (66.7%) i.e. Diabetes mellitus (33.3%). The overall QOL was satisfactory (58.28+11.5). Highest mean QOL scores were in the area of dialysis staff encouragement (87.50), and symptoms (83.01). The lowest mean score of QOL was in the area of burden of kidney disease (32.27), and role physical (38.78). Highest QOL scores in the area of ‘dialysis staff encouragement’ emphasises on the role of nurses and health care team in optimising the QOL of patients on CAPD.

Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey

High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). Cross-sectional national survey. National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0. Most respondents (72.8%) worked≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. Limited generalizability to all US dialysis PCTs. More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.