Abstract: SA-PO706
Cost Effective Model for Bone Mineral Disease Management in Hemodialysis Population in Qatar
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Mohamed, Mohamed Yahya, Hamad Medical Corporation, Doha, Qatar
- Al-Ali, Fadwa S., Hamad Medical Corporation, Doha, Qatar
- Hamad, Abdullah, Hamad Medical Corporation, Doha, Qatar
Background
Hemodialysis population have multiple comorbidities with high morbidity and mortality. High calcium level contributes to vascular calcification and increased cardiovascular mortality in the dialysis population. Hypercalcemia, hyperphosphataemia and high parathyroid hormone level are related to vascular calcification and increased cardiovascular mortality. On our annual report we found suboptimal MBD results in 2015. That is why a change was needed.
Methods
BMD team consisted of 2 part-time nurses and a nephrologist who provided extensive training for 2 months to work almost independently. We started April 2016 and followed theses target for calcium. We followed this available target for calcium (<2.37 mmol/L), phosphorus (<1.75 mmol.) And PTH (150-600 pg/mL) or >800 pg/mL (negative outcome). Nurse review the results within 4 days after blood extraction with the nephrologist and prescription were written simultaneously (physician prescription is mandatory), Data collection was done under IRB approval.
Results
all first-floor patient's (176/380) were included. Over a short period, we were able to achieve our targets. There was statistically significant difference in the number of patients in target range for PTH in interventional group compared with standard care group in the ground floor (43% versus 17%), (P value <0.005), and PTH less than 800(15% versus 83%),(P Value 0.0006). Through proper accounting for medicine dispensing, we were able to reduce number of prescription and pill burden. Reduced number of sevelamer tablets estimated at 4.5 tablets/Week/Patient (average of 30 tablets/week/patient in the new model versus 34.5 in the standard of care) with annual course surfing estimated at 60,000 $. Cinacalcet consumption dropped from 430 mg/week/patient to 370mg/week/patient with an annual cost saving of 125000 US dollars.
Conclusion
MBD nurse manager model in dialysis was successful to achieve, exceed and maintain patients within benchmark for calcium, phosphorus, and PTH.