ESPN 50th Annual Meeting

ESPN 2017


 
Modification of Young Adult Outcomes on Haemodialysis- Changing ‘’our’’ Practice
MARIE-LOUISE TURNER 1 Jisha Matthews 1 Helen Cronin 1 Fiona Sinclair 1 Joyce Popoola 1

1- St George’s University Hospitals NHS Foundation Trust
2- St George’s University of London Medical School
 
Introduction:

Young adults (YAs) with end stage renal disease (ESRD) face unique complex physical, psychological and social challenges making them particularly vulnerable. Those with ESRD on haemodialysis (HD) have an over tenfold increase burden of cardiovascular co-morbidity and mortality when compared to contemporaries, significantly reducing their life expectancy. This contrasts with a fourfold increase when compared to older patients and their contemporaries.

All YAs on our St George’s renal database were surveyed (Have your say!) in 2014, to ascertain changes they would like to see in the renal unit to improve their patient experience. Peer support opportunities featured in over 70% of responses. Additionally, an adherence assessment of our YAs showed 100% of the YAs on HD had adherence issues. We therefore elected to assess whether providing peer support opportunities could improve haemodialysis outcomes for this patient group.

Material and methods:

We targeted our YAs (18-25 years) on haemodialysis population and offered them the opportunity of forming a cohort on the Monday, Wednesday & Friday twilight shift 5.30(6.00) pm to 9.30(10.00) pm, as a preparatory survey identified later dialysis away from the weekend to be the preferable option for the majority of the YAs. Six of our young adults demonstrating low adherence were cohorted and followed up in our Young Adult Clinic. 

Results:

Attendance and completion of dialysis sessions significantly improved in this cohort. There has also been a reduction in hospital admissions and length of stay among our young adults as well as reduced intra-dialysis weight gain. The Young Adults at St George’s hospital are consistently achieving Urea Reduction Ratios (URR) above the Renal Association (RA) Guidelines 65%. URR scores have increased steadily across the young adult cohort population between 2015 and 2017 similarly to Haemoglobin levels. Bone health however has remained suboptimal over this period. 

 

Parameter

2015

2016

2017

Missed Dialysis Sessions

20.8%

4.8%

3.5%

URR

69.9%

77.3%

83.65%

Haemoglobin (mean)

90g/dL

103g/dL

107.8g/dL

PTH (mean)

76.7pmol/L

51.1pmol/L

72.2pmol/L

Table: Demonstrating change in some of the parameters assessed including dialysis attendance, dialysis adequacy, haemoglobin and bone health.

Additionally, reported qualitative data shows wellbeing improved as young adults gained awareness of other young adults on dialysis, formed friendships and utilised the opportunity for peer support. 

Conclusions:

The cohorting of YAs together, on to the monday, wednesday, friday haemodialysis twilight shift, has significantly improved the attendance and completion of dialysis sessions in this patient group. In addition patients have reported improved wellbeing. Bone health however has remained suboptimal and should remain a focus for future improvment. The care of our YAs on haemodialysis was highlighted as excellent practice on the recent National Care Quality Commission (CQC) and peer review visits in 2016.