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S 29 Parallel Session
Programme of the Session
Title: CKD prevention & delay
GS: Josep Mª Gutierrez (Spain)
Eldery & CKD. Dialysis for all?
O 75
A programme of early detection of CKD improves patient identification and outcomes
Marie Richards (United Arab Emirates)
O 76
Pre-dialysis: set-up of an improved structure
Sarah Crols (Belgium)
O 77
Effects of systematic predialysis patient training on the clinical results
Aydin Zehra (Turkey)
O 78
Awareness of chronic kidney disease by primary care clinicians in Abu Dhabi
Allam Rezquallah (United Arab Emirates)
Abstracts
GUEST SPEAKER
Eldery & CKD. Dialysis for all?
J. Mª Gutierrez
Abstract is not available
BIOGRAPHY OF THE GUEST SPEAKER
O 75
A programme of early detection of CKD improves patient identification and outcomes
M. Richards1, A. Rezqallah1, N. Richards1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates
Background
The prevalence of CKD2-5 in Abu Dhabi is >20%. The dialysis prevalence is 1000 per million of the Emerati population and >90% of patients present to dialysis as an emergency which obviates the possibility of upstream preventative strategies, early access creation and pre-emptive transplantation. The dialysis population is set to double in the next 5-8 years. An algorithm driven, community based programme of early detection of CKD, with online decision support and renal community nurses within primary care was introduced in February 2014 to address this problem.
Objectives
To assess the impact of the programme and describe factors associated with progression of CKD.
Methods
Data (demographics, laboratory, medication, comordids) were collected on all outpatients with two eGFR recording between February 2014 and March 2015. Logistical regression and multivariate analysis were used to assess associations with progression.
Results
10,739 patients were identified, 26% demonstrated progressive CKD. Progression was associated with uncontrolled blood pressure (OR 1.33, p<0.006), diabetes (OR 1.43, p<0.001), congestive heart failure (OR 1.71, p<0.001), hypertriglyceridaemia (OR 1.22 per μmol/l, p<0.001) and the progression risk (KDIGO) yellow, amber and red (OR 1.28, p<0.001, 2.71, p<0.01, 3.63, p<0.001 respectively). The prescription of NSAIDs fell progressively by 41% in primary care and 35% in secondary care and declined with increasing CKD level. NSAID prescription was not associated with CKD progression. AVF at first dialysis increased from 2.6% in 2013 to 13.9% to 2014 and 22.5% in 2015.
Conclusion/Application to practice
This early detection programme clearly led to a dramatic improvement in patient identification and timely management.
O 76
Pre-dialysis: set-up of an improved structure
S. Crols1, N. Van Paesschen1, M. Roden1, K. François1, C. Tielemans1, Nursing Staff Haemodialysis Unit UZ Brussel1
1Dialysis Department, UZ Brussel VUB, Brussel, Belgium
Background
The aim of a pre-dialysis education program (PDEP) is to inform and prepare patients as much as possible for their renal replacement therapy (RRT).
Objectives
Evaluate the pre-dialysis education program of a university hospital, modify it, and evaluate the changes.
Methods
Information of the time between the first pre-dialysis clinic visit and dialysis start, eGFR at the first visit and follow-up appointment of all new pre-dialysis patients was collected during 2 years to evaluate the ongoing PDEP. A survey was conducted and results compared with the data collection. To improve the pre-dialysis clinic an improved structure was set up. Patient information forms were introduced to guarantee individualized RRT information. A year after the PDEP modification, the same data was collected and compared with those of the initial PDEP.
Results
In the former program, 105 patients visited the pre-dialysis clinic of which 41% had no follow up. The mean eGFR at first visit amounted 12mL/min/1.73m² and the mean dialysis-start was 70 days after the first visit. Within the new structure patients were referred earlier to the pre-dialysis clinic, which resulted in a better prepared dialysis start.
Conclusion/Application to practice
With the improved structure, more patients were included in the pre-dialysis program and had a better follow up. Patients who started RRT after program modification are better informed, started with treatment of their own choice and had a suitable dialysis access. The pre-dialysis nurses give adapted information thanks to the patient information form and more attention is given to the pre-transplant options.
BIOGRAPHY OF THE SPEAKER
O 77
Effects of systematic predialysis patient training on the clinical results
Z. Aydin1, S. Ozcan2
1Health Science Institution, Koc University, Istanbul, Turkey; 2School of Nursing, Koc University, Istanbul, Turkey
Objectives
Aim was to compare the effectiveness of predialysis education on clinical results,
self-care ability , quality of life and psychological status of patients who have already
started dialysis treatment
Methods
Totally 202 patients (108 who have attented a systematic education programme-the case group; and 94 who have not taken any education-the control group) enrolled onto the study. Data regarding quality of life, self-care capacity and depressive condition were obtained through Short Form-36 Scale, Self-care Scale, Patient’s Health Questionnaire( PHQ-9) as well as through Patient’s Definition Form which includes sociodemographic, clinical and biochemical results of patients. Ethics aprroval was obtained.
Results
The mean of self-care score in control group (82,35±21,48) was found lower than the mean of self-care scores in the case groups (98,04±11,38 and 98,33±8,45) (p<0,001). The frequencies of moderate and severe depression were more than the frequencies of case groups (respctiveley 31,9 % vs 20,2 % and 12,8 %; p<0,001). The mean scores of SF-36 and its subscales as physical functions, physical roles, pain, general health, emotional functions and mental health in case group were higher than those scores in the control group (p<0,001). “EPO”, “Phosphate”, “PTH”, “Creatinine” and “BUN”values, which are determinants of inadequate dialysis, were significantly high in the control group(p<0,01).
Conclusion/Application to practice
These results indicated that the systematic predialysis patient education helped to improve the quality of life, developed self-care capacity, increased psychosocial health by decreasing depressive features and thus brought a positive effect on the clinical results.
O 78
Awareness of chronic kidney disease by primary care clinicians in Abu Dhabi
A. Rezqallah1, N. Alqaissi2, D. Dowsett3, C. Greenway3, P. Byers3, A. Cullimore1, N. Richards1, M. Richards1
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
Chronic kidney disease is common in Abu Dhabi but late presentation suggests that awareness, particularly in primary care is low. An algorithm based, automated detection programme with online decision support was introduced in February 2014.
Objectives
This study assessed the awareness of primary care clinicians regarding the identification, referral and treatment of patients with CKD 18 months following the introduction of the early detection programme.
Methods
A quantitative, descriptive, web based survey (SurveyMonkey™), administered to a sample of clinicians in chronic disease clinics in primary care was used to assess levels of awareness of CKD. The survey covered three themes, CKD awareness, indications for referral and medication. Answers were deamed to be correct or incorrect.
Results
The response rate was 47% of study the population (n=99), 76.5% female, 40% with 10-20 years of work experience. In theme 1 the correct responses ranged from 27.9% - 97.8%. In theme 2 from 42.5% - 89.3% and in theme 3 from 68.0% - 80.8%.
Conclusion/Application to practice
Answers to theme 1 suggested good overall awareness of CKD with the majority of respondents being aware of the algorithm although there was little understanding of the appropriateness of dialysis counselling at different CKD levels. In theme 2 89% of respondents were happy with timing of patient referral but 42% thought referral at CKD 1 was appropriate. Theme 3 suggested that there was good awareness of the harmfull effects of NSAIDs and the benefical effects of ACEi. Overall awareness of CKD and its management appeared to be good although with some confusion.