S 19 Parallel Session

Fifteen years ago, we established programmes for unplanned start on PD and for assisted APD (aAPD) in order to increase the number of patients managed on a home based dialysis and to give more patients a real choice of dialysis modality selection.

Unplanned start on PD is offered to the late referred patients with urgent need for initiation of dialysis. Assisted APD is offered to the growing group of older patients with ESRD who are usually not candidates for PD due to advanced age and a heavy burden of comorbidities. Assistants are professional nurses or health care technicians briefly educated by PD nurses from our dialysis unit. They are offered 3 hours of theoretical training at their office and 3 hours of practical training in the patient’s home at discharge from hospital. It is our goal to make both the patient and the assistants confident with the treatment and the procedures while constantly focusing on the patient’s well-being and resources to keep them as independent as possible. We have documented, that unplanned start on PD is not associated with increased risk of infectious complications and has no negative effect on long term PD catheter survival.
Assisted PD is an evolving dialysis modality, and may in the future prove to be a feasible complementary alternative to HD for the growing group of dependent older patients with ESRD. Unplanned start on PD and aAPD may also be useful tools to increase the number of patients managed on a home based dialysis modality.

BIOGRAPHY OF THE GUEST SPEAKER

O 39
Renal nurses’ perceptions regarding establishment of a home haemodialysis program in Abu Dhabi
J. Lee¹, N. Alqaissi², D. Dowsett³, C. Greenway³, P. Byers³, A. Cullimore¹, N. Richards¹, M. Richards^1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates; ²Nursing, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates; ³Health Faculty, De Montfort University, Leicester, United Kingdom

Background
End Stage Renal Disease (ESRD) is recognized as a significant public health problem in Abu Dhabi. The ESRD population grows by 8-10% annually. Globally the self care model of home dialysis is recognized as a viable RRT. As yet there is no such program in Abu Dhabi.

Objectives
The purpose of this qualitative study was to explore renal nurses’ perceptions of the requirements for establishing HHD program in Abu Dhabi.

Methods
A purposive sample of renal nurses with previous experience of home haemodialysis participated in a semi-structured face to face interview and a thematic analysis was used to analyze the data.

Results
Three major themes with sub-themes emerged. Theme 1: Knowledge about home haemodialysis based on western experience, theme 2: requirements of home haemodialysis within the self-care model, and theme 3: The western self-care model of home haemodialysis is perceived to be unachievable locally. Whilst the usual obstacles to such a programme (space, utilities supply, committed carer etc) were identified the largest obstacle appeared to be the local culture of a nurse dependent care.

Conclusion/Application to practice
This study identified the key elements and the requirement for establishing HHD based on western experience and provides a basis for establishing a viable HHD program in Abu Dhabi. Based on the qualitative data collected a service development project plan was proposed as a viable pilot for a HHD program in Abu Dhabi. It is clear from this survey that an alternative model of self or assissted care will need to be developed to overcome local cultural issues.
 BIOGRAPHY OF THE SPEAKER 

O 40
Home dialysis versus in-centre dialysis
V. Galego¹, M. David¹, R. Peralta², T. Carvalho¹, J. Fazendeiro Matos², M.T. Parisotto^3
1NephroCare DAD Lumiar, Fresenius Medical Care, Lisboa, Portugal; ²NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; ³Care Value Management EMEA, Fresenius Medical Care, Bad Homburg, Germany

Background
Home haemodialysis (HHD) allows the patient, after completing a training programme of 16 weeks, to perform dialysis treatments at home 24hours/day. The HHD program includes nursing support and promotes self-care, autonomy, patient comfort and quality of life.

Objectives
• Compare clinical outcomes and medication consumptions in HHD with in-centre haemodiafiltration (HDF).

Methods
From January to December 2014 we compared clinical data of 9 patients performing HHD (group A) with data of 10 randomly selected in-centre patients on HDF (group B). Relevant clinical data were Kt/V, Hb, ferritin, albumin and ESA, iron, antihypertensive consumption.
The Wilcoxon-Mann-Whitney test was applied.

Results
Comparing data of group A versus group B revealed:
• an average age of 62.88±4.90 versus 63.60±4.78 years; p=0.466;
• 1diabetic versus 2 diabetics:
• 4 patients (44.5%) versus 6 patients (60%) consumed antihypertensive medication.
Age-adjusted Charlson Comorbidity differences between both groups were not statistically significant.
Furthermore, the following average levels were obtained for group A versus group B:
Hb: 11.42±1.08g/dl versus 11.15±1.06g/dl; p=0.057;
ESA: 0.73±0.71µg/kg versus 1.44±1.23µg/kg; p<0.001;
Albumin: 4.05±0.29g/dl versus 4.10±0.49g/dl; p=0.916;
Ferritin: 487.30±230.16ng/ml versus 665.75±369.39ng/ml; p<0.001;
Iron mg/kg/month: 2.08±0.18 versus 2.50±0.13; p=0.027;
Kt/V: 1.51±0.25 versus 1.90±0.39; p<0.001;
Effective treatment time: 240min versus 238min.

Conclusion/Application to practice
There was no difference in outcomes between both groups besides a lower ESA consumption in HHD and a higher Kt/V in in-centre dialysis. Differences in Kt/V are probably justified by the different prescriptions (haemodialysis versus HDF). With HHD we can offer efficient treatment which could probably help reduce costs for the NHS (e.g. caused by the transportation to the dialysis centre).
BIOGRAPHY OF THE SPEAKER

O 41
Renalpro, an excellent problem solving and experience disemination tool
A. Marti Monros¹, L. Seco Lozano¹, T. Garcia Fornieles¹, I. Fonfria Perez¹, J.F. Martinez Martinez¹, A. Sanz Escriba¹,E. De La Iglesia¹, R. Ortells Corresa¹, L. Quevedo^1
1Nephrology, CHGUV, Valencia, Spain

Background
RenalPro is a neutral forum, free of any Industrial interest, making the bridge between renal care workers, worldwide. In 1994, Rob Huizinga RN(Canada), launched  an email-based discussion forum, hosted and sponsored by University of Alberta Canada.  Chairs have been: Bobbie Knotek(USA), Andre Strgier(Belgium) and Elizabeth Lindley(UK). in 2003 was agreed to switch to a full moderation of this forum to avoid: auto responders messages, product advertisements, computer virus spread, unsuitable postings...
Subscribers are from more than 46 countries.

Objectives
To describe how RenalPro can easily contribute to problem solving and experience dissemination.
To stimulate use of RenalPro to improve renal patient care and professional development.

Methods
Our  Nephrology Department  decided to re-open our Home Haemodialysis (HHD) program.
The first action was to make a literature research in order to identify "state of the art" of different aspects of HHD.
We also decided to send a request for information on:
1. checklist prior to sending patients home for HHD.
2. strategies to identify potential HHD patients.
The request was accepted by the RenalPro chair.

Results
We received valid information from countries around the world, describing their experience, concerns, practical protocols on  HHD and links to different webs, from Nurses, Technicians, Managers, Educational professionals…the information has been a valid resource of information  when setting up our own program.

Conclusion/Application to practice
Using RenalPro is one of the easiest ways, maybe the best one, to receive up to date information in different aspects of renal care, subscribers can share or alert their colleagues for any practice problem and/or ask for advice.
BIOGRAPHY OF THE SPEAKER

O 42
Legal blindness and home haemodialysis: the challenge of unassisted therapy
H. Provencher¹, J. St-Jean¹, L. Nolin¹, R. Bell¹,  A.C. Nadeau-Fredette^1
1Department Medecine Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montréal, Canada

Background
A legally blind patient with loss of peripheral vision requested to perform home haemodialysis in our nocturnal home haemodialysis program. The 64-year-old patient's aim was to pursue home haemodialysis treatment by himself, including cannulation of the arteriovenous fistula using the buttonhole technique. In our program, blindness was classically considered an exclusion criteria due to heightened risks of infection, infiltration and technical errors.

Objectives
We hypothesized that the patient could safely perform home haemodialysis with a specific training where adapted tools and devices were used to manage needles, tubing system and connections in a safe and ergonomic approach.

Methods
We evaluated the patient's ability to combine precision and action despite his visual impairment. A step-by-step method was developed to guide the patient through the different stages of the process: reading, tubing assembly, cannulation technique and connections. We collaborated with the Montréal Institute Nazareth and Louis-Braille (experts in visual impairment support) to find the appropriate visual aid device. We optimized the patient's partial vision by using adapted ergonomic approaches to manipulate needles and mirror effect reflection of the magnifier.

Results
Special training allowed this patient to perform unassisted home haemodialysis. After a follow-up of 15 months only one infiltration occurred, No infections occurred. Once dialyzing at home, a few additional adjustments were needed to optimize his cannulation technique.

Conclusion/Application to practice
Motivation, special training and creativity allowed sucessful use of home haemodialysis. This positive experience resulted in the reassessment of visual impairment as a contraindication to home haemodialysis in our program.