Hemodialysis Setting Research Articles

The Impact of COVID-19 Infection Control Measures on End-Stage Renal Disease Patients in a Community Hemodialysis Setting.

Several non-pharmaceutical infection control measures have been implemented at community-based hemodialysis centers to reduce the risk of Coronavirus Disease of 2019 (COVID-19) transmission,caused by the SARS-CoV-2 virus.However, there have been concerns that such measures may disrupt the routine and timely care required by patients, with adverse effects on their health outcomes.This cross-sectional study aims to determine the unintended consequences of COVID-19 infection control measures on hemodialysis patients. Electronic medical records were extracted from patients enrolled in community-based hemodialysis centers in Singapore.A baseline group prior of patients consisted of those enrolled in 2017, which was three years prior to the SARS-CoV-2-related pandemic (n = 548).This was compared with the study group of patients enrolled in 2019 (n = 426), just before the COVID-19 pandemic started.Medical records for these two groups were extracted from Januaryto July 2018 for the baseline group and from January to July 2020, respectively. Three regression models were built to study dialysis adherence, kidney disease biomarkers, and hospitalization episodes. There was no statistically significant difference in hospitalization and mortality outcomes, adherence to dialysis management, laboratory results for dialysis-related clearance, and anemia outcomes. There was a higher proportion of patients hospitalized for vascular access-related reasons in the study group as compared to the baseline group (OR 1.6, 95% CI: 1.10 to 2.29, P = 0.014).Patients in the study group had albumin levels 2.13% higher (95% CI: 0.88 to 3.39, P < 0.001) and alkaline phosphatase levels 7.3% lower (95% CI: 1.17 to 13.02, P = 0.020) than those in the baseline group. From this community-based hemodialysis study in Singapore, it was shown that the COVID-19 pandemic did not disrupt regular healthcare services for these patients.With strategies instituted fora coordinated health delivery workflow, ensuring sufficient capacity in the various healthcare delivery sites and overall pandemic preparedness, the patient clinical outcomes measures continued to be met with no adverse consequences noted.Some improvements in dialysis-related laboratory values and quality of care targets may be due to more stringent measures instituted to protect these vulnerable patients in the community.

Standardizing Blood Pressure Measurements in Pediatric Hemodialysis: a Collaborative Journey.

This manuscript details the development and execution of a quality improvement (QI) initiative aimed at standardizing blood pressure (BP) measurement practices in pediatric hemodialysis (HD) units across a national dialysis collaborative. Although there are recommendations for the detection and treatment of hypertension in the pediatric population, currently there is no data or recommendations specific to the methodology of measuring blood pressure in a pediatric hemodialysis setting. In 2016, the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) Collaborative assembled a dedicated working group to thoroughly examine BP measurement practices across participating pediatric HD centers and, drawing from current research, to establish a standardized best practice for BP measurement in pediatric HD patients both in-center and at home. Employing QI methodology, the working group devised a standardized "BP Bundle" and implemented it throughout the SCOPE Collaborative. This work led to successful practice improvement by establishing a consistent approach to BP measurement in pediatric HD patients cared for in SCOPE centers. With a standard best practice now in place and over 85% compliance with the BP Bundle across the SCOPE Collaborative, researchers and healthcare professionals can more accurately study and ultimately enhance the cardiovascular health of pediatric HD patients.

#6634 PATIENTS' PERSPECTIVES ON HAEMODIALYSIS ACCESS: A QUALITATIVE STUDY

Abstract Background and Aims There is high quality evidence that favours the use of arteriovenous fistulas (AVFs) over central venous catheters (CVCs) for haemodialysis access, based on the association with lowest mortality and fewest complications [1]. However, less is known regarding patient and nurse preferences concerning access choices and the drivers underlying these preferences. One previous study [2] identified physical concerns regarding fistulas as the predominant barrier preventing patients with a CVC from switching to an AVF. Here we provide an expansion on these barriers, alongside novel exploration of nursing opinion on access choice. Methods Data was collected through individually administered patient surveys across 4 regional dialysis sites in East Anglia (n = 380), and anonymised online survey requests to nursing staff at the sites. Deductive and inductive strategies were employed for analysis of the qualitative data. The aim of the thematic analysis of the data was to determine the preferred access modality of patients and nurses, and the drivers for the preferences. Results 63% (n = 238) of patients responded to the questionnaire. Patient responses fell into one of four categories; drivers toward, or barriers against AVFs or CVCs. The largest of these categories was the barriers for AVFs, within which four main themes were identified: ‘Fear’, ‘difficult AVF surgery’, ‘patient preference for lines’ or ‘patients awaiting AVF surgery or transplant’. A smaller theme of ‘insufficient information’ regarding access choice was also identified. ‘Fear’ was the largest theme, within which five subthemes were identified: fear of needles, pain, bleeding, fistula appearance, or fear of complications heard from other patients on the dialysis unit. ‘Difficult AVF surgery’ encompassed two subthemes; those who have had previous failed traumatic attempts or those whose current vascular architecture was not amenable to fistula surgery. The other three categories received far fewer responses. The AVF driver category focussed on fistulas being preferred medically with reduced infection risk, whilst drivers for lines included it being ‘comfortable’ and patients saying that the line works for them. The one comment in the CVC barrier category cited difficulties experienced with lines like blockages and infections. 13 responses were received from dialysis nurses. All respondents were aware of the medical preference for patients to have a fistula, and the reasons why. Nurses themselves also preferred their patients to have fistulas, referencing the same reasons. However, most nurses thought patients preferred CVCs, and were able to cite the same reasons as the patients themselves. Lastly, nurses reported that they convey the benefits and risks of different access types correctly when asked by patients at the dialysis units. Conclusion These findings highlight that, whilst doctors and nurses focus on long-term health benefits of AVF when discussing vascular access choices, patients are focussed on the immediate potential risks of an AVF. We hypothesise that, whilst dialysing, patients share stories of fistula-related complications that drive short-term fear of AVFs, with such impact that the messages conveyed by health professionals are often negated. This difference in agendas is essential to acknowledge. The relationship between clinician, nurse and patient in the haemodialysis setting is unique given its longevity, frequency of contact, and holistic nature. Implementing a strategy to bridge this agenda gap could strengthen this relationship and provide a basis for optimum, evidence-based treatment. We therefore suggest the use of positive patient AVF experiences, delivered via peer education sessions, as a tool to introduce drivers for, and uptake of, AVF for dialysis patients in the future.

Model-Informed Precision Dosing of Vancomycin in Adult Patients Undergoing Hemodialysis.

Model-informed precision dosing (MIPD) maximizes the probability of successful dosing in patients undergoing hemodialysis. In these patients, area under the concentration-time curve (AUC)-guided dosing is recommended for vancomycin. However, this model is yet to be developed. The purpose of this study was to address this issue. The overall mass transfer-area coefficient (KoA) was used for the estimation of vancomycin hemodialysis clearance. A population pharmacokinetic (popPK) model was developed, resulting in a fixed-effect parameter for nonhemodialysis clearance of 0.316 liters/h. This popPK model was externally evaluated, with a resulting mean absolute error of 13.4% and mean prediction error of -0.17%. KoA-predicted hemodialysis clearance was prospectively evaluated for vancomycin (n = 10) and meropenem (n = 10), with a correlation equation being obtained (slope of 1.099, intercept of 1.642; r = 0.927, P < 0.001). An experimental evaluation using an in vitro hemodialysis circuit validated the developed model of KoA-predicted hemodialysis clearance using vancomycin, meropenem, vitamin B6, and inulin in 12 hemodialysis settings. This popPK model indicated a maximum a priori dosing for vancomycin-a loading dose of 30 mg/kg, which achieves the target AUC for 24 h after first dose with a probability of 93.0%, ensured by a predialysis concentration of >15 μg/mL. Maintenance doses of 12 mg/kg after every hemodialysis session could achieve the required exposure, with a probability of 80.6%. In conclusion, this study demonstrated that KoA-predicted hemodialysis clearance may lead to an upgrade from conventional dosing to MIPD for vancomycin in patients undergoing hemodialysis.

The shape of water - preliminary data from a cluster of patients infected by Mycobacterium saskatchewanense in Haemodialysis setting in Emilia-Romagna, Northern Italy

The shape of water - preliminary data from a cluster of patients infected by Mycobacterium saskatchewanense in Haemodialysis setting in Emilia-Romagna, Northern Italy

A Systematic Literature Review of Safety Culture in Hemodialysis Settings.

Safety culture is an important aspect of quality in healthcare settings. There are many risks that patients can encounter in hemodialysis settings one of which is the infection risks due to the regular need to access bloodstreams using catheters and needles. Implementation of prevention guidelines, protocols and strategies that reinforce safety culture excellence are essential to mitigate risks. The objective of this study was to identify and characterize the main strategies that enhance and improve patient safety culture in hemodialysis settings. Medline (via PubMed) and Scopus were searched from 2010 to 2020 in English. Terms defining safety culture, patient safety were combined with the term hemodialysis during the search. The studies were chosen based on inclusion criteria. A total of 17 articles reporting on six countries were identified that met inclusion criteria following the PRISMA statement. From the 17 papers, practices that were successfully applied to improve safety culture in hemodialysis settings included (i) training of nurses on the technologies used in hemodialysis treatment, (ii) proactive risk identification tools to prevent infections (iii) root cause analysis in evaluating the errors, (iv) hemodialysis checklist to be used by the dialysis nurses to reduce the adverse events, and (v) effective communication and mutual trust between the employee and leadership to support no-blame environment, and improve the safety culture. This systematic review provided significant insights on the strategies that healthcare safety managers and policy makers can implement to enhance safety culture in hemodialysis settings.

“You need a team”: perspectives on interdisciplinary symptom management using patient-reported outcome measures in hemodialysis care—a qualitative study

BackgroundPatient-reported outcome measures (PROMs) are standardized instruments used for assessing patients’ perspectives on their health status at a point in time, including their health-related quality of life, symptoms, functionality, and physical, mental, and social wellbeing. For people with kidney failure receiving hemodialysis, addressing high symptom burden and complexity relies on care team members integrating their expertise to achieve common management goals. In the context of a program-wide initiative integrating PROMs into routine hemodialysis care, we aimed to explore patients’ and clinicians’ perspectives on the role of PROMs in supporting interdisciplinary symptom management.MethodsWe employed a qualitative descriptive approach using semi-structured interviews and observations. Eligible participants included adult patients receiving intermittent, outpatient hemodialysis for > 3 months, their informal caregivers, and hemodialysis clinicians (i.e., nurses, nephrologists, and allied health professionals) in Southern Alberta, Canada. Guided by thematic analysis, team members coded transcripts in duplicate and developed themes iteratively through review, refinement, and discussion.ResultsThirty-three clinicians (22 nurses, 6 nephrologists, 5 allied health professionals), 20 patients, and one caregiver participated in this study. Clinicians described using PROMs to coordinate care across provider types using the resources available in their units, whereas patients tended to focus on the perceived impact of this concerted care on symptom trajectory and care experience. We identified 3 overarching themes with subthemes related to the role of PROMs in interdisciplinary symptom management in this setting: (1) Integrating care for interrelated symptoms (“You need a team”, conducive setting, role clarity and collaboration); (2) Streamlining information sharing and access (symptom data repository, common language for coordinated care); (3) Reshaping expectations (expectations for follow-up, managing symptom persistence).ConclusionsWe found that use of PROMs in routine hemodialysis care highlighted symptom interrelatedness and complexity and helped to streamline involvement of the interdisciplinary care team. Issues such as role flexibility and resource constraints may influence sustainability of routine PROM use in the outpatient hemodialysis setting.

Live music during haemodialysis: A multiple methods randomised controlled pilot study.

Fatigue is an immense problem among patients undergoing haemodialysis and is associated with anxiety and depression. Live music used in different hospital settings has shown promising effects, but the feasibility and potential effectiveness of live music during haemodialysis are unknown. To evaluate the feasibility, the participants' musical experience and potential effectiveness of live music on patients' levels of fatigue, relaxation, anxiety, depression, treatment satisfactionand work engagement among nurses. A pilot randomised controlled trial evaluated with a multiple methods design. Two clusters of 12 patients were each randomised to receive either 30 min of live music once a week during haemodialysis or usual care over a period of 6 weeks. The primary outcome was patients' immediate fatigue. Other outcomes were patients' long-term and post-dialysis fatigue, relaxation, anxiety, depression, treatment satisfactionand work engagement among nurses. Observations and semi-structured interviews with patients, nursesand musicians were conducted to gain an in-depth understanding of the musical experience as well as feasibility. The study was feasible and detected significant differences on immediate fatigue (p < 0.001) and anxiety (p < 0.012) in the intervention group compared to controls. Among 17 nurses, a significant difference was found in Dedication (p < 0.024). Furthermore, live music gave patients an uplifting experience, bringing joy and relaxationand the nurses experienced a sense of quietness in a stressful day. Providing live music performed by professional musicians in a haemodialysis setting is feasible and showed a significant effect on immediate fatigue and anxiety compared to controls.

Identifying Patient Satisfaction Determinants in Hemodialysis Settings: A Systematic Review.

PurposePatient satisfaction is a measure of care quality that assists providers in determining the effectiveness of their services while meeting patients’ expectations. This study aimed to review existing studies that have focused on patients’ satisfaction determinants in Hemodialysis (HD) settings.MethodsElectronic databases (PubMed, ScienceDirect, Scopus, and Google Scholar) were searched from 2000 onwards to identify studies using search terms related to patient satisfaction and hemodialysis centers. Article review was limited to studies written in English. A total of 19 articles were included by following the PRISMA statement. Data were extracted using a structured form and summarized in a tabular format to identify different determinants that showed a relationship with patient satisfaction. Determinants were classified into provider-related determinants and patient-related characteristics.ResultsProvider-related determinants of patient satisfaction in HD centers include staff, facility, service, and treatment. Patient-related characteristics associated with satisfaction include demographics and health status history. Based on this systematic review, key correlates of patient satisfaction in hemodialysis centers include: staff, facility, service, treatment, patient’s demographics, and health status.ConclusionThe findings of this study can help healthcare facilities in taking measures in line with the specified determinants to enhance patient satisfaction and improve the organizational performance of the healthcare centers. It is important to constantly study and improve these determinants based on patient feedback to improve patient satisfaction and quality of care.

Musical Breaks-Live Music in a Hemodialysis Setting-A Qualitative Study on Patient, Nurse, and Musician Perspectives.

The aim of this hermeneutic-phenomenological study was to explore the perspectives of 12 patients, 17 nurses, and 4 musicians on patient-tailored live music interventions in a hemodialysis setting. Twenty-six semi-structured interviews were collected—17 with patients, 9 with nurses. Furthermore, 18 moderate participation observations, whilst 1 semi-structured group interview with 3 nurses and 3 musicians, and 13 reflective journals from musicians were collected. Within the analysis—based on Ricoeur’s theory of interpretation—two overall themes emerged: (1) the inner space and (2) the participating space, followed by five subthemes: (1a) Entering a calm and enjoyable pause bubble; (1b) Resting in a thought-free state of mind; (1c) Traveling in the past and catching the moment through heartfelt music; (2a) Bringing positive changes into life; (2b) The artistic quality mediating a magnificent and beautiful experience. We found that patient-tailored live music was a meaningful break, influencing mental and physical well-being, time perception, community, work environment, and artistic approach. The artistic quality of the music was essential—together with the musicians’ social awareness, empathy, and ability to interact with the patients—in creating meaningful moments for patients and staff. Overall, the music interventions were a welcome change in a predictable world of stressful routines and repetitive treatments.

Patient and Staff Perceptions on Using Bioelectrical Impedance Analysis in an Outpatient Haemodialysis Setting: A Qualitative Descriptive Study.

Bioelectrical impedance analysis (BIA) is an objective hydration and body composition assessment method recommended for use in haemodialysis patients. Limited research exists on the acceptability and utility of BIA in clinical practice. This qualitative study explored patient and staff acceptability and perceived value of BIA in an outpatient haemodialysis setting at a tertiary public hospital in Queensland, Australia. Participants included five patients receiving outpatient haemodialysis and 12 multidisciplinary clinical staff providing care to these patients. Semi-structured interviews were employed and data were analysed thematically. Patients were satisfied with the BIA measurement process and most thought the BIA data would be useful for monitoring changes in their nutrition status. Clinical staff valued BIA data for improving fluid management, assessing nutrition status and supporting patient care. Staff recommended targeting BIA use to patient groups who would benefit the most to improve its uptake in the haemodialysis setting. Conclusions: BIA use in the outpatient haemodialysis setting is acceptable and provides valuable objective data to support health-related behaviour changes in patients and enhance clinical practice. Implementation of BIA should be tailored to the local context and staff should be supported in its use.

Textual Organization of Hemodialysis Nursing Practice: An Institutional Ethnography.

Nursing today deals with organizational changes and reforms within the increased demands of care amid competing resources. In some developing countries, dealing with text documents is a challenge in hemodialysis service organizations. This study aimed to explicate the social organization of textual nursing practices in a hemodialysis unit of a public university hospital in Nepal. This is a qualitative study that followed institutional ethnography design. Ten registered nurses who worked for at least six months in the hemodialysis unit were included for in-depth interviews. Data were also collected through 167 hours of observations, field notes, and two focus groups. Texts including policy, protocols, and record documents were incorporated in the analysis. Data analysis followed Smith's (1987) institutional ethnographic analysis. Nepalese nursing work in a hemodialysis unit was mainly organized by the free hemodialysis policy of the government which was not available to the nurses at the hemodialysis unit, but it determined most of the nursing activities of patient care and documentation. Hemodialysis record form, hemodialysis schedule, and free hemodialysis claim form also had a great influence on nursing work. However, the nurses were not quite aware of how the textual documents determined their practices to meet the politico-economic interests of the hospital and government. The hospital and Nepal's health ministry established the activities and recording requirements. Identification of texts and exploration of their influences on nurses' decisions, patient care, and documentation are essential to find the optimal solutions in daily care and determine the appropriate support for nurses in hemodialysis settings.

MO863: Electronic Patient Reported Outcome (EPRO) Collection in Dopps: Prospective Study Designed to Understand the Severity and Temporal Changes in Pruritus Symptoms in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Chronic kidney disease-associated pruritus (CKD-aP) is often seen to affect 30–40% of hemodialysis (HD) patients, and baseline CKD-aP symptoms have been associated with worse quality of life, poor sleep quality, depression and survival. A need exists for documenting CKD-aP severity longitudinally via several CKD-aP instruments to allow for temporal evaluation of different domains of CKD-aP burden, and their relationships to other patient-reported outcomes (PROs). This will help to further inform the extent to which different domains of well-being are impacted by CKD-aP over time, and its variability across patients, for tailoring individualized clinical care of HD patients afflicted by CKD-aP. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort of adult in-centre HD patients, with patients randomly selected from representative national samples of HD facilities. Many prior studies by DOPPS and others have used only a baseline measure of CKD-aP, which may underestimate the strength of the true associations with clinical outcomes. With more frequent data collection to update exposures and understand trajectories, we can better evaluate the extent to which CKD-aP is episodic versus chronic. We can also assess whether patients with more consistently severe CKD-aP have worse PROs than patients who are currently—but only recently—bothered by CKD-aP. These gaps in knowledge present an opportunity to undertake a prospective study to link longitudinal clinical data with focused and frequent capture of CKD-aP and PROs to better understand the prevalence, burden and management of CKD-aP from HD patients’ perspectives. METHOD This prospective electronic PRO (ePRO) study involves &amp;gt;100 HD units from the 7 European countries participating in DOPPS 7 (Belgium, France, Germany, Italy, Spain, Sweden, UK). The ePRO will be distributed at HD facilities at 3-month intervals during an 18-month data collection period from 2021–3. The ePRO will be offered to all patients enrolled in the DOPPS, yielding a potential sample of 2000–500 patients based on expected participation and return rates (∼67%). The ePRO data collection is focused on use of mobile (tablet, phone) devices used frequently by patients, but will also be operational on a desktop or laptop computer. Patients will use their personal device to scan a unique QR code, and typically complete the questionnaire while on site at their HD facility. The ePRO will include a combination of validated CKD-aP scales, general quality of life related instruments and healthcare resource utilization (HCRU), i.e. patient reported capture of itch medications and specialist visits known to the patient but not typically in the dialysis chart. A complete list of the ePRO components is shown in Table 1. These ePRO data, together with linked longitudinal clinical data captured in DOPPS, will serve as the analytical basis for several planned research projects, including (i) comparing approaches to measure CKD-aP burden; (ii) describing within-patient trajectories of CKD-aP burden and associations with PROs; and (iii) CKD-aP and short-term outcomes including HCRU, hospitalization and mortality in the 3-months following each CKD-aP assessment. RESULTS Data collection is underway as of August 2021, with initial data expected in early 2022. While not yet available, we expect to present preliminary descriptive data at the ERA-EDTA in May 2022. CONCLUSION The community lacks longer-term, frequently captured data on pruritus severity and management in the HD setting. This DOPPS 18-month prospective ePRO will help address novel research questions investigating the longitudinal burden of pruritus from the patient perspective, using multiple validated instruments and relationships to PROs, clinical outcomes and healthcare resource utilization.

Detection of hepatitis C virus (HCV) RNA by PCR among hemodialysis patients attending a tertiary care centre, Mysuru, South India

The infection rate of Hepatitis C virus in chronic hemodialysis (HD) patients is comparitively higher than the normal population. Hepatocellular carcinoma and cirrhosis are the major complications that have been frequently reported among the patients with HCV infection who were on hemodialysis. Hence, continuous monitoring of HCV infection in hemodialysis settings at health care centres may aim towards the assessment and prevention of device induced infection. Hence this current study was aimed to detect the HCV RNA using PCR among hemodialysis patients attending JSS, a tertiary care centre situated in Mysuru, South India.

Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh.

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000–40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60–90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.

Transformation of Clinical Nursing Practice Following a Caring-based Educational Intervention: A Qualitative Perspective.

IntroductionHemodialysis (HD) patients experience numerous physical and psychological symptoms on a daily basis. These symptoms have a heavy impact on their quality of life, which is a key indicator of their survival in the short term. Numerous empirical studies have shown that the quality of the nurse-patient relationship (NPR) is essential in promoting positive outcomes for patients. When patients receive caring, their autonomy and independence grows, their sense of hope increases, their quality of life improves, and their sense of satisfaction with nursing care received rises. Inversely, the presence of dehumanizing practices in hemodialysis settings can contribute to delay healing for patients. In light of the importance of the quality of the relationship between nurses and HD patients and of the benefits to be had from a quality relationship, an educational intervention based on Watson's Theory of Human Caring was delivered to HD nurses.ObjectiveThe purpose of this study was to explore qualitatively the perceptions of nurses working with HD patients in French-speaking Switzerland regarding changes to their clinical practice after receiving an educational intervention intended to reinforce caring attitudes and behaviors towards patients.MethodsThe method used was that of consensual qualitative research (CQR). Sixteen semi-structured interviews were conducted with hemodialysis nurses post-intervention.ResultsThe results evidence a transformation of clinical nursing practice illustrated by three core ideas: (1) caring practice was reinforced; (2) new practices emerged; and (3) some limitations appeared.ConclusionIn these times of global pandemic where the issue of the humanization of nursing care is front and center, this professional development activity helped reinforce caring-based practice. This practice needs to be developed within the various care units in order to guarantee and promote quality of care and patient safety.

Practices and pitfalls in medication adherence in hemodialysis settings \u2013 a focus-group study of health care professionals

BackgroundMedication nonadherence is common among patients with hemodialysis, leading to poorer patient outcomes. Health care professionals have an important role in assessing risk of nonadherence and intervening to support adherence. The aim of this study was to explore physicians’ and nurses’ current medication adherence practices in hemodialysis settings.MethodA generic qualitative design with inductive content analysis and focus group methodology. Focus groups with health care professionals were conducted in four Nephrology Centers, representing three different regions of Denmark. An interview guide was developed in collaboration with 3 patient representatives.ResultsSix focus group interviews involving a total of forty-two health care professionals were conducted. Five main categories were identified; Laboratory tests are the “gold standard” for assessing adherence, suggesting that abnormal results motivated investigation of adherence, Varying practices for supporting adherence, alluding to the impact of individual clinician priority and preference on choice of adherence interventions, Unclear allocation of roles and responsibility, specifically referring to uncertainty in the delegation of roles between physicians and nurses, Navigating time and resource limitations, intimating the resources needed to support medication adherence and Suggestions for future strategies.ConclusionsWe suggest implementing systematic use of validated patient-reported outcome measures for assessing adherence and deprescribing tools to support adherence, as these instruments might identify the patients who are in most need of support and promote patient adherence to their prescribed medications. The findings also point to a need for interdisciplinary clarification of roles and responsibilities regarding medication adherence, with the aim of building a strong collaborative partnership between professions.

Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis.

Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.

Consensus-Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting

Hyperkalemia (serum K+ >5.0mmol/L) is commonly observed among patients receiving maintenance hemodialysis and associated with increased risk of cardiac arrhythmias. Current international guidelines may not reflect the latest evidence on managing hyperkalemia in patients undergoing hemodialysis, and there is a lack of high-quality published studies in this area. This consensus guideline aims to provide recommendations in relation to clinical practice. Available published evidence was evaluated through a systematic literature review, and the nominal group technique was used to develop consensus recommendations from a panel of experienced nephrologists, covering monitoring, dietary restrictions, prescription of K+ binders, and concomitant prescription of renin-angiotensin-aldosterone system inhibitors. Recent studies have shown that K+ binders reduce the incidence of hyperkalemia, but further evidence is needed in areas including whether reduced-K+ diets or treatment with K+ binders improve patient-centered outcomes. Treatment of hyperkalemia in the hemodialysis setting is complex, and decisions need to be tailored for individual patients.

Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study

ObjectivesPatients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs)...