The impact of dialysis adequacy on patient outcomes

Abstract:

This abstract underscores the pivotal connection between dialysis adequacy and patient outcomes in end-stage renal disease (ESRD) individuals. The metric Kt/V, which assesses dialysis adequacy, emerges as a critical determinant influencing patient survival, healthcare resource utilisation, and overall quality of life. Historically, Kt/V monitoring has been selectively applied to specific patients within our dialysis unit. However, this article strongly advocates a paradigm shift towards the universal implementation of Kt/V monitoring for all patients requiring dialysis.

Through comprehensive Kt/V monitoring, we can introduce personalised, evidence-based care tailored to the unique needs of each patient undergoing dialysis. This approach aims to optimise patient outcomes and elevate the overall quality of care across diverse patient profiles.
 We can foster a proactive and preventative healthcare approach by extending the application of Kt/V monitoring to encompass all individuals needing dialysis. This strategy has the potential to mitigate adverse outcomes, reduce healthcare resource utilisation, and enhance the overall well-being of ESRD patients. In conclusion, the universal adoption of Kt/V monitoring stands as a transformative initiative with far-reaching implications, promising to significantly improve the standard of care within dialysis units and positively impact the lives of those navigating the challenges of end-stage renal disease (Dunbar, Badr, Moukalled, & Mezher, 2023).

Reference

Dunbar, G. B., Badr, L. K., Moukalled, Z., & Mezher, H. (2023). Effects of Exercise on Physiologic and Psychologic Outcomes in Patients with End Stage Kidney Disease on Hemodialysis: A Quasi-Experimental Study. Nephrol Nurs J, 50(2), 123-130.

 

 

Kimberley Renal Services provides services for early stages of CKD and also dialysis for 165 people. Historically the model of care included a renal GP in each centre to provide CKD care in remote communities and management of dialysis patients in each centre. Since 2020 KRS has struggled to recruit a renal GP to each centre relying on the renal SMO working part time to cover the work of 3 full time renal GPs. 

KDOQI Clinical Practice Guidelines recommend biannual nutrition screening for patients on haemodialysis. Routine nutrition screening at the Royal Melbourne Hospital (RMH) satellite dialysis units is not routine care and the nutrition risk profile in this cohort is unknown. Malnutrition is associated with decreased quality-of-life, and higher rates of morbidity and mortality. Effective nutrition risk identification will ensure timely access to nutrition care.

Skin irritation related to Haemodialysis Central Venous Cather (HD CVC) dressings and cleaning solutions was observed to be more common in, but not exclusive to, patients of Asian and Polynesian ethnicity with moderately-brown skin. Management of this condition is challenging especially in humid and hot climates. A flowchart to assist with the management of HD CVC related skin irritation was designed, implemented, and evaluated.

Constipation in patients receiving peritoneal dialysis (PD) remains a major problem and is associated with increased risks of mechanical and infectious complications. Psyllium husk has been identified as a potential alternative therapy for constipation. There have been several studies conducted on the benefits on psyllium husk in the general population, however its efficacy, safety and tolerability in patients receiving PD remain unknown.  

The combined chronic kidney disease (CKD) and renal supportive care (RSC) clinic was organised to support and assist older people with advanced CKD in shared decision making (SDM). 

A sentinel event in 2023 highlighted deficiencies in the assessment and documentation of central venous access devices (CVADs), including haemodialysis catheters, by ward nurses. This prompted the implementation of ward-based initiatives to enhance patient safety and outcomes.

Falls is a common complication experienced by patients with kidney disease due to the illness decreasing individual’s physical function. An investigative analysis using an incident reporting tool was conducted which identified that majority of falls occurrence involves renal patients needing overnight toileting. A collaborative project between nursing and allied health team was develop to improve this outcome. 

This unique case involves a 53-year-old woman of New Zealand European/Pakeha descent with end-stage renal disease on maintenance Hemodialysis who successfully managed Calciphylaxis through a combination of increased dialysis, diligent wound care, debridement, and sodium thiosulfate infusion. The rarity of Calciphylaxis in this population, coupled with the effective treatment approach, makes this case particularly noteworthy for healthcare professionals.

Indigenous led Outreach Education for First Nations people of Queensland, focused on improving access to and equity in Kidney Transplantation.