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S 07 Parallel Session
Programme of the Session
Title: Challenge of multimorbidity
GS: John Harty (UK)
Managing multi-morbidity in haemodialysis patients – a personalised approach
O 09
Granulomatous hypercalcemia due to Crohn’s disease in a haemodialysis patient
Zuleyha Alici (France)
O 10
Pneumococcal vaccination in dialysis patients in Saudi Arabia – a performance improvement project
Joy Barrios (Saudi Arabia)
O 11
Patients in haemodialysis experience uremic pruritus as a dual phenomenon
Helene Tarp (Denmark)
O 12
Epidemiology of moderate and severe psoriasis in greek patients on renal replacement therapy
Chrysanthi Avrami (Greece)
Abstracts
GUEST SPEAKER
Managing multi-morbidity in haemodialysis patients – a personalised approach
J. Harty1
1Renal Unit, Daisy Hill Hospital, Southern Health and Social Care trust, Newry, United Kingdom
Background
In the UK patients aged over 65 represent the fasted growing group of the dialysis population. They have a high burden of co-morbidity and polypharmacy. Malnutrition and reduced physical quality of life is common. They are less likely to be offered transplantation. Their dialysis course is often characterised by an increase in fraility, accelerated decline and reduced life expectancy.
Objectives
To understand the type, frequency and impact of co-morbid diseases in the HD population.
To identify successful interventions in managing common co-existing diseases (diabetes, PVD)
To identify key objectives which improve outcome in the multi-mordid HD cohort.
To understand the role of paliative care in symptom management.
Methods
I will focus on the practical aspect of managing common co-existing diseases in HD patients. I will review the evidence for effecive intervention to reduce the cardio-vascular burden.
The importance of specialist nurse input in tailoring specific care to patients with diabetes and the importance of a vascular team to reduce amputation is stressed.
I will discuss the importance of symptom control in frail patients and the importance of early palliative care input.
Finally I will discuss the essential components of a HD review.
Results
Despite an increasingly elderly population, longterm survival of incident dialysis patients continues to improve with falling death rates from cardiovascular disease and a plateauing in infection. Withdrawal from dialysis is increasing.
Conclusion/Application to practice
Targeted intervention to reduce the burden of co-existing disease with modification of aspects of dialysis care can improve outcomes. Recognition of decline should be reflected in realistic patient goals.
BIOGRAPHY OF THE GUEST SPEAKER
O 09
Granulomatous hypercalcemia due to Crohn's disease in a haemodialysis patient
Z. Alici1
1Nephrology, CH Louis Jaillon, Saint Claude, France
Background
Normo calcemic end stage renal failure alerts us for a possible coexisting disease associated hypercalcemia or activated macrophage and dendritic cells leading to extra renal UN alpha hydroxylation of vitamin D.
Methods
A 86 year old man was dialyzed due to the evolution of multiple emboli cholesterol syndrome to end stage renal failure. He has history of pulmonary tuberculosis treated with quadruple therapy in 1970, arterial hypertension, benign prostatic hypertrophy under Tamsulosine, operated peri anal abscess and abdominal aortic aneurysm treated surgically. He was found to have hypercalcemia secondary to a confirmed diagnosis of Crohn's disease that improved under corticoid therapy.
Results
Dysregulation of calcium homeostasis is very common in dialysis patients. Hypercalcemia associated Crohn disease was previously described and our particular case confirms it. Normalized calcium level after the start of prednisolone pointed the granulomatous origin.
Conclusion/Application to practice
Granulomatous form of Cohn’s disease may present with hypercalcemia due extra renal hydroxylation of vitamin D in the presence of renal failure.
O 10
Pneumococcal vaccination in dialysis patients in Saudi Arabia - a performance improvement project
J.M. Sedgewick1, J. Barrios1, T.W. Habhab2, E. Al-Jehani1
1Department of Nursing Affairs, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; 2Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
Background
Saudi Arabia welcomes 2-3 million pilgrims annually to perform Hajj, a lifetime religious duty for all Muslims. Dialysis patients require protection against communicable diseases arising from the influx of pilgrims. The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal conjugate vaccine to chronic renal failure patients. Vaccine administration other than hepatitis B, were administered by the hospital Family Medicine Department. This was time consuming leading to patients travelling to Mecca, without being vaccinated and arriving back with illness requiring antibiotic treatment.
Objectives
To improve pneumococcal vaccination rates amongst dialysis patients travelling to Mecca to perform Hajj.
Methods
The Focused PDCA methodology identified dialysis patients not receiving pneumococcal vaccination. The project involved collaboration with Logistics Department, Nursing Education, Pharmacy and Medical team. A special fridge connected to a central system ensured stable vaccine temperature and potency. Pneumococcal vaccines were provided by pharmacy and nursing education provided education on vaccine administration. Unit policies were revised reflecting the expanded practice of renal nurses. Educating patients and family focused on the benefits and of protective health behaviors
Results
The project spanned January to December 2015. The initial vaccination target was 10% (n=8) of dialysis patients frequently travelling to Mecca. By May 2015, the target reached was 30% (n=23). Vaccination uptake until Dec. 2015 reached 95% (n=54).
Conclusion/Application to practice
This project demonstrated the impact renal nurses have on implementing preventive health strategies to protect patients. Renal nurses promoted patient health, improving their morbidity and mortality. Collaborative work with Pharmacy, Nursing Education, Logistics Department and Physician was crucial to this project.
O 11
Patients in haemodialysis experience uremic pruritus as a dual phenomenon
J. Finderup1, H. Tarp1, 2, M. Bonde-Petersen2
1Departement of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark; 2University College VIA, Aarhus N, Denmark
Background
Uremic pruritus is one of the most frequent symptoms in patients in haemodialysis. Existing studies show that uremic pruritus increases quality of life and sleep. Patients find it difficult to describe their symptoms to healthcare professionals. This may lead to misunderstandings in the communication between patients and healthcare professionals.
Objectives
To explore how patients in haemodialysis experience the phenomenon uremic pruritus.
Methods
A qualitative phenomenological-hermeneutic framework was used to explore the experience of uremic pruritus. Fifteen semi-structured interviews were made at a Danish university hospital in November 2015. The interviews were transcribed and analysed using Malterud’s principles of systematic text condensation.
Results
Patients gave conflicting descriptions of the phenomenon. Patients experienced uremic pruritus as a dual phenomenon described as ‘the itch’ and ‘itching’. ‘The itch’ will never disappear and is unmanageable, and ‘itching’ is appearing intermittently and is possible to prevent and alleviate.
Conclusion/Application to practice
It is impossible for patients on their own to manage uremic pruritus. However, it may be possible to manage uremic pruritus by considering it as a dual phenomenon. This knowledge can help both patients and healthcare professionals to understand the symptom from a new perspective.
BIOGRAPHY OF THE SPEAKER
O 12
Epidemiology of moderate and severe psoriasis in Greek patients on renal replacement therapy
C. Avrami1, O. Delimarkou1, A. Zezou1, S. Zorbas1, A. Schoinas1, D. Karathanasis1
1Dialysis Unit, 401 Military Hospital of Athens, Athens, Greece
Background
Psoriasis is an inflammatory disease of the skin estimated to affect almost 2% of the general Greek population. Recent studies link moderate and severe psoriasis to an increased risk of Chronic Kidney Disease, but there is shortage of data regarding the prevalence of psoriasis in the population with ESRD.
Objectives
The aim of this study is to estimate the prevalence of moderate or severe psoriasis in Greek patients on renal replacement therapy, mainly on dialysis and define the impact their therapy has on the eruption.
Methods
A cross-sectional study was conducted. We designed a self administered questionnaire with 16 questions pertaining to patient's CKD history, comorbidity, psoriasis severity and evolution in association with the introduction of renal replacement therapy. The survey was conducted in various hospital-based and private renal units in cities and islands all over the country. The patients participated on an anonymous basis.
Results
36 renal units were included in the survey. 25 patients with moderate or severe psoriasis were identified corresponding to 0,87% of the total population examined, which is 38% higher than in the general non-dialysis dependent population. In addition 36% of the patients with moderate or severe psoriasis reported significant improvement after starting dialysis.
Conclusion/Application to practice
This study implies that patients with moderate or severe psoriasis are more likely to suffer from end-stage renal disease. We also suspect that in patients who suffer from both diseases, the inflammation and psoriasis severity depends on the existence of a dialyzable factor.