Abstract: TH-PO260
Personalized Hemodialysis vs. Standard Therapy: Is a Change Needed?
Session Information
- Hemodialysis, Hemodiafiltration, and Frequent Dialysis
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
- Suarez, Miguel, Servicio Extremeno de Salud, Merida, Spain
- Garcia Bernalt, Vanesa, Servicio Extremeno de Salud, Merida, Spain
- Dorado, Pedro, Universidad de Extremadura, Badajoz, Spain
Background
In our unit, hemodialysis therapy is personalized based on patient characteristics and available techniques: conventional versus incremental, high-flow, extended, supra-HD, in-line, or mid-dilution. Since 1970 we have reduced the objective to an adequate KT/V, forgetting about other uremic toxins until the arrival of the online modality. In the study area there are two concerted centers with standard therapy (90% High-Flow and 10% Postdilutional On-line) and public centers with personalized therapy.
Methods
Retrospective study of 205 (n 84 vs 121) incident patients comparing the application of a personalized hemodialysis protocol vs. standard therapy. Study period 2015-2021 with a minimum observation period of 24 months or until event. Costs obtained from the prices of public tenders and contracted personnel for HD performance. Determine whether personalization is justified compared to standard therapy, compared to the associated clinical variables (pharmaceutical expenditure, hospital admission and mortality).
Results
Number of admissions 84 (72.4%) vs 32 (27.6%) in favor of the personalized therapy group; this represents an average of 10.78 vs 4.97 (p < 0.005) days of admission per 365 days of treatment. Risk Estimate 0.082 (0.335-0.666) vs 0.295 (1.374-2.516). According to public tenders, the price per session for Personalized vs Standard is €173.4 vs €129. The indirect cost per year for Personalized vs Standard is: in Pharmacy €2,988 vs €6,308 in Admission €4,478.46 vs €9,713.85 and in Incremental HD - €1,484.06 vs - €0. Costs that fall on the hospital center.
Total cost is the sum of direct plus indirect cost: €27,050.4 + €2,988 + €4,478.46 - €1,484.06 vs €20,124 + €6,308 + €9,713.85 - €0 therefore €33,032.26 in personalized therapy vs €36,145.85 standard therapy.
In the binary logistic regression, the factors related to the risk of admission (analyzed DM, Cardiopathy, catheter days, Age of Start, Sex and Chalson Index) with statistical significance are personalized therapy, initial vascular access and sex.
Conclusion
Despite the limitations of the study, retrospective and observational, personalizing therapy seems to reduce the morbidity and mortality associated with the technique, achieving greater efficiency of it. It is necessary to design a study to this effect to determine the need to personalize therapies in the SES authorized centers.