Abstract: TH-PO299
Dedicated Patient Optimization Program Improves Lives of Vulnerable Patients
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Penny, Jarrin D., London Health Sciences Centre, London, Ontario, Canada
- Deleaval, Patrik, NephroCare Tassin-Charcot, Saint Foy-les-Lyon, Auvergne-Rhône-Alpes , France
- McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada
Background
Industrialized 'one size fits all' approaches to care and reliance on single intervention-based strategies results in negative outcomes for many. In response we developed and applied a systematic patient optimization program (POP) applying individualization and complex interventions to support the needs of the most vulnerable patients aiming to improve both the subjective experience and objective tolerability of dialysis.
Methods
Patients (19) with inadequate response to conventional care were identified over a 12-month period. A series of comprehensive baseline objective (physiological, hemodynamic) and subjective assessments were performed and complex foundational/patient-disease specific interventions applied and rigorously evaluated over two weeks. Subjective impact was assessed using dynamic daily patient reported outcome measures. Objective assessments (inclusion and monitoring response) included continuous hemodynamic monitoring, tissue perfusion, vascular ultrasound and intradialytic echocardiography with assessment of HD-induced cardiac injury (myocardial stunning).
Results
Nineteen patients, largely with issues related to hypotension & failure to achieve target weight- in concert with a range of negative symptoms. All patients had multiple components of dialysis altered. POP was associated with a marked improvement in a range of subjective and objective outcomes. QOL improved by 20% (p0.02), recovery time by 86% (p0.005). Reductions in intradialytic systolic BP improved by 19% (p<0.01), interdialytic weight gain 33% (p0.01) and myocardial stunning was significantly reduced (by 63% p0.01) with tight association between changes in BP (p<0.001) and ultrafiltration (p<0.05). At inclusion all patients had been declined transplantation listing, after re-evaluation 3/19 were listed and two successfully received graft.
Conclusion
A complex intervention delivered in a systematic POP improves the subjective wellbeing and objective tolerability of HD in the most challenging patients.