Mrs VILMA LLEVA1, Mrs MAREE ROSS-SMITH1, Mrs SIVATHA ROS1
1Austin Health, Melbourne, Australia
Biography:
Vilma is the Nurse Unit Manager of the Acute Haemodialysis Unit and Dialysis Coordinator at Austin Health in Melbourne, a role she has held since 2012.
Her renal career spans over 35 years, having initially trained in the Philippines. Vilma completed her postgraduate renal nursing training in Saudi Arabia and has practiced internationally across Ireland, the United Kingdom, and Australia.
Vilma is deeply passionate about patient-centred care and innovation. She is committed to delivering the highest standard of care and continually strives to improve outcomes for every patient under her care.
Abstract:
Background:
Haemodialysis (HD) remains the cornerstone therapy for patients with end-stage kidney disease (ESKD) however, uncertainty persists regarding optimal dosing strategies. Conventional HD prescriptions commonly follow a standardised model that does not account for individual patient variability, particularly residual kidney function (RKF).
Aim:
This project aims to introduce an individualised HD prescription strategy using an incremental HD approach. HD dosing is tailored according to the patient’s RKF. Those with higher RKF commence on a lower HD prescription, whilst those with minimal RKF require a higher HD prescription.
Methods: Incremental HD involves regular monitoring of RKF, using timed urine collections in conjunction with serum urea and creatinine results. HD adequacy measurements including urea reduction ratio and Kt/V are also used to determine and adjust the HD prescription.
A structured protocol was developed incorporating the following key components:
- Enhanced patient quality of life throughout the HD journey.
- Careful patient selection based on RKF.
- Close monitoring to ensure clearance targets are met, with flexible prescription adjustments.
- Monthly multidisciplinary team reviews, supported by a dedicated clinical database.
Results:
Since July 2018, 158 patients have commenced incremental HD representing 7-10% of the dialysis cohort at our centre.
Conclusion:
Incremental HD has demonstrated significant benefits for patients and providers by:
- Providing a safe and effective option for patient with adequate RKF.
- Improved quality of life through reduced treatment burden.
- Improved patient engagement.
- Expanded HD service capacity.
- Efficient resource utilisation.