FP674A STUDY OF VARIABILITY IN DIALYSIS SCHEDULES AND ITS DECISION MAKING IN HOME HAEMODIALYSIS

Abstract

Introduction and Aims: Patients and caregivers place the highest value on outcomes that will enable them to maintain their day-to-day well-being and lifestyle in Home Haemodialysis. This is commonly attributed to the choice of individualised dia-lysed schedules that are varied between patients to fit in with their preference and lifestyle. However, the variation of schedules for each individual over time and its prescribing has not been studied. We aim to analyse patient autonomy and intra-patient variability in dialysis scheduling in a Home Haemodialysis (HHD) programme. Methods: An online 10-point questionnaire was designed based on the literature review of outcomes and burdens of HD and home HD schedules available. Participants were eligible if they were an adult in self-care HD programme, either on home HD or in-centre self-care HD. Demographic data was collected, which included age, gender, occupation status, along with information about dialysis procedures, such as involvement of a care partner or family member, current dialysis schedule and time of the day of therapy performance, autonomy in changing a dialysis schedule and dynamic of dialysis schedule. Descriptive statistical analysis was made using the IBM SPSS Statistics 22 software. Results: 44 HD patients and in-centre self-care patients participated in the study, 72.1% were male. Mean age was 51.4 612.4 years and total length of renal replacement therapy 102.5 691.9 months. Mean HHD therapy vintage was 48.5 653.5 months. HHD was the first modality in 45.5% of the patients, 36.4% had at least one previous transplant and 22.7% had previously performed peritoneal dialysis. A care partner for some help with treatment steps was present in 38.6% of the cases, 11.3% for needling, and 54.5% were dialysing alone at home. 50% of the patients dialyse 3 times per week with a two-day gap during the week, 29.5% preform dialysis every other day, 15.9% dialyse 4 and 4.5 hrs 5 times per week. 54.6% dialyse 5 hours or more per session and 15.8% less than 4 hours. Patients dialyse during the morning, afternoon, evening and night in 24.4%, 19.5%, 14.6% and 12.2% of the cases, respectively, and in 29.3% of the cases, the time of the day is variable. When a change is made in the dialysis schedule, 78.6% of the patients mentioned that they were involved in the making the change. In 79.1%, 63.4%, 60.5% and 59.5% of the cases, any change was made in a period of a week, 3,6 or 12 months, respectively. Over a period, 25-50% of the schedules were changed in 20.9%, 36.6%, 34.2% and 37.8% on a weekly, every 3,6 or 12 months, respectively (Table 1). In 41.2%, 41.7% and 47.2% of the cases a care partner, the community nurse and physician were involved as well, respectively (20.6%, 19.4% and 22.2% in all the schedules).$$table-{429B8E8A-34B1-4759-9C64-6F1239E4CD78}$$ Conclusions: Unlike Incentre haemodialysis, there appears to be significant variability in the HHD scheduling for each patient either on a weekly or monthly basis. 25-50% dialysis schedules are altered in a third of HHD patients. Majority of alterations are led by patients themselves. This is one of the first study reporting on the flexibility and patient autonomy in dialysis schedules at home. Clinical assessments, biochemical interpretation, outcome measures and trials in HHD need to consider this important and unique feature in HHD practice.