Dr Lap Cheng1, Donia George1, Debbie Pugh1, Camila Miranda1, Chanchal Sharma1, Natalie Waters1, Jeffrey Ha1,2,3
1Department Of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 2Faculty of Medicine & Health, University of New South Wales, Sydney, Australia, 3Renal and Metabolic Division, The George Institute for Global Health, UNSW Medicine & Health, Sydney, Australia
Biography:
Bio to come
Background:
There is limited evidence to guide the management of patients undergoing twice-weekly or incremental haemodialysis to reduce the burden of dialysis on patients and carers, and in view of dialysis capacity constraints. We comprehensively characterise a cohort of patients who initiated twice-weekly haemodialysis in a tertiary kidney service in regional Australia.
Methods:
Since November 2023, a working group comprising a nurse practitioner, dialysis nurse champions, and nephrologists have held monthly multidisciplinary meetings to monitor 14 patients who have received twice-weekly haemodialysis for >3months across 4 dialysis units in the Illawarra-Shoalhaven Kidney Service. Eligibility for twice-weekly haemodialysis included residual urine output >600mls daily and ≥5 of the following: interdialytic weight gain <2.5kg, stable cardiovascular status, infrequent hospitalisation, satisfactory health-related QOL, absence of hyperkalaemia >6.0mmol/L or profound anaemia. Baseline clinical characteristics within 3-months of initiating/transitioning to twice-weekly haemodialysis, and reasons for discontinuation were verified from electronic medical record.
Results:
Of 14 patients receiving twice-weekly haemodialysis for >3months, median(SD) age was 68 years(16.61), 36% female, 64% diabetic, median starting eGFR 7 mL/min/1.73m2 (of which 6 were pre-existing dialysis patients with mean dialysis vintage 10.6 months). At initiation of twice-weekly haemodialysis, 13 eligible patients had average residual urine output 1.35L daily and 64% were on diuretics. Median time on twice-weekly haemodialysis was 8.8 months. Median survival from initiation of twice-weekly haemodialysis has been >16.8 months to date. Reasons for discontinuation of twice-weekly haemodialysis included: fluid overload (3), physician preference (2), refractory hyperkalaemia (1), and withdrawal from dialysis (1).
Conclusions:
Twice-weekly haemodialysis is feasible for a heterogenous patient cohort in regional Australia. Further studies are needed to assess long-term survival, patient-important outcomes, and its cost-effectiveness compared with thrice-weekly haemodialysis.
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