418C - Research Paper

Abstract:
Case Description:
A clinical review of vascular access, diet, medications, dialysis prescription, and residual kidney function was conducted for an 82-year-old gentleman to investigate the cause of his ongoing hyperkalaemia. The potential causes were addressed individually, but he remained hyperkalaemic and asymptomatic. He then presented to dialysis with severe leg weakness, and a life-threatening spike in serum potassium to 8.1 mmol/L. Thorough re-examination and a literature search led to a connection with a previously undisclosed turmeric/glucosamine preparation that the patient was taking for arthritic pain.

Discussion:
This case study highlights the potential risks associated with the use of over-the-counter medications by patients with CKD on haemodialysis. It also emphasises the importance of scrutinising all patient’s medications including over-the-counter and herbal supplements and educating patients about the possible harmful effects of these preparations.

Conclusion:
Timely and thorough investigation of hyperkalaemia and patient education are essential to prevent these life-threatening situations.

411 - Research Paper 

Abstract
Aim:
To determine the rate of out-of-range post-haemodialysis blood glucose levels, the rate of out-of-range post-haemodialysis blood glucose levels that are clinically acted upon, the type of intervention and outcome of each intervention, and the associations between post-haemodialysis blood glucose levels and relevant clinical predictors. 

Method:
We conducted a 12-month retrospective cohort medical record review in one Australian haemodialysis centre. Post-haemodialysis blood glucose levels, pre-haemodialysis blood glucose levels, time of treatment, diabetes medications, intradialytic fluid removal, dialysate dextrose concentration, clinical actions, interventions, and outcomes on out-of-range blood glucose levels were retrieved. 

Results:
1703 haemodialysis sessions were analysed from 22 participants aged 67 + 12 years, with a median time receiving dialysis 3.1 years (IQR 2.3-4.7). The proportion of out-of-range post-haemodialysis blood glucose levels was estimated to be 87.3% (95% CI, 86.1% to 88.5%). No out-of-range post-haemodialysis blood glucose levels were clinically acted upon and there were no intervention episodes or outcomes of these interventions in the study sample. Out-of-range post-haemodialysis blood glucose levels were 4.6 times more likely if a 2g/l compared to a 1g/l dextrose bath was used (95% CI:3.3; 6.3. p<0.001). The odds of the post- haemodialysis blood glucose levels being out-of-range increased by 34% as the pre-haemodialysis blood glucose levels increased by each 1 mmol/L. Intradialytic fluid removal, dialysate dextrose concentration, sex, dialysis time, anti-hyperglycaemic agents were also associated with out-of-range post-haemodialysis blood glucose levels. 

Conclusion:
Routine post-haemodialysis blood glucose levels testing has limited clinical utility in the routine care for people with diabetes receiving haemodialysis. Higher dextrose dialysate may require individual titration depending on pre- and post-haemodialysis blood glucose levels. 

454Q - Research Paper

Abstract
Aim:
To establish a Nephrology service at a stand-alone heart hospital, to allow for the provision of a haemodialysis service.

Method:
Development of the model of care for the service including processes, leadership and governance. The development of the Renal – Cardio Clinical Nurse Consultant (CNC) role to provide a liaison between the service and the offsite main nephrology unit. Education and training of staff from both sites. Set up of haemodialysis compatible bed spaces, implementing storage and supply processes. Clear communication of service capabilities and limitations. Streamlined communication between the main dialysis unit and the renal-cardio CNC. 

Results:
The establishment of 8 haemodialysis rooms and the successful provision of 124 haemodialysis treatments. We have seen no increase in on call demands since commencement. Key success has been linked to the defined role of the Renal-Cardio CNC. The ability of the CNC to provide key relationship building between all stakeholders, to be the visible point of reference for the nephrology service on site. 

Conclusion:
Whilst there has been challenges in setting up and providing haemodialysis services without a dedicated unit, we have been able to successful implement a “fly in fly out” service led by the Renal-Cardio CNC, Nephrology team and the Acute Haemodialysis unit. 

449Q - Research Paper

Abstract
Aim:
Presentation will highlight the establishment of NKFSamoa, its essential services and identifying challenges and innovations experienced by the NKFSamoa in a resource constraint environment while ensuring these essential services are sustained for the people of Samoa. 

Method:
NKFS recent evaluation of statistics gathered from its medical screenings and outreach programs, suggests a prevalence of CKD in Samoa of 34.6%. This estimate suggests that given a population of about 200,000, there would be 42,212 people living with CKD in Samoa. This is a very high number compared to global rates 

Results:
Currently the number of patients requiring dialysis increased dramatically and the conditions these patients presented with were well advanced in kidney failure that there was no other intervention needed except initiating dialysis. From NKFS data for the 443 people that were on dialysis during the 10 years, 2012 – 2022, over 80% of them had End Stage Renal Failure due to unmanaged or poorly managed diabetes and/or hypertension.  Haemodialysis patients increased by 200%, more than 80% of patients in the pre-dialysis clinic were lost to follow up and our screening program was effective in detecting however lacking in management of people identified with CKD. 

Conclusion:
These numbers would suggest that Samoa will continue to experience a constant increase in people needing renal replacement therapy. This assumption is held true by having a new high of 66 new dialysis patients for the Financial Year ending 30 June 2023.

400Q - Research Paper

Abstract
Aim:
This study examined the predictors of suboptimal interdialytic weight gain among haemodialysis patients.

Method:
A cross-sectional study was conducted among haemodialysis patients from five dialysis units affiliated to a large metropolitan hospital in Melbourne, Australia. Demographic and clinical data were collected from electronic medical records. Interdialytic weight gain was calculated from a midweek run. Regression analysis were performed to determine factors associated with suboptimal interdialytic weight gain

Results:
A total of 269 patients (62% female) with a mean (SD) age of 65.8 (14.8) years participated. Sixty percent were from culturally and linguistically diverse background (CALD) and 44% had severe comorbidity status based on the Charlson Comorbidity Index. With respect to socioeconomic status, 114 (42.4%), 65 (24.1%) and 90 (33.5%) of patients belonged to the most disadvantaged, intermediate and most advantaged groups respectively. The mean (SD) absolute and relative IDWG was 1.68 (0.97) kilograms and 2.17 (1.34) % respectively. The relative IDWG for patients from CALD backgrounds was 43% higher compared to those from non-CALD background and patients who dialysed with arteriovenous fistulas had higher relative IDWG compared to those who had other forms of access. Base weight was negatively correlated to relative weight gain (all p values in adjusted analyses <0.05).

Conclusion:
Among patients on hemodialysis, being from CALD background and dialysing with an access other than an arteriovenous fistula was associated with higher relative IDWG derived from a midweek run. Identifying these factors will inform the timely implementation of interventions targeted at subgroups who experience suboptimal IDWG such as those from CALD backgrounds .

507C - Research Paper

Abstract
Case Description:
59yo man on HD 3x week with Class 2 obesity (BMI 35.4kg/m2) attended the metabolic rehabilitation clinic and was commenced on OzempicR as part of his weight loss program with the plan to be listed for a renal transplant.  A fortnight after commencing OzempicR he began complaining of increasing abdominal pain. Upon investigation he informed the staff he had not moved his bowels in 15days. 

Discussion:
Despite the GLP-1Ras being hailed as the golden ticket for people struggling with obesity they are not without their risks and cannot be used in isolation. The underlying cause of obesity is multifaceted including but not limited to lower levels of education, poverty, food deserts, and therefore the treatment of obesity should be multifaceted.  The task for the dialysis staff then became how to manage dialysis treatment – with unrealistic weight loss expectations and associated side effects 

Conclusion:
Patients are looking for the “golden ticket” to assist with weight loss and the GLP-Ras are being hailed as such, however they must be viewed as part of a suite of interventions. The challenge for the dialysis team is how to support the patient while they explore these options and maintain a safe treatment environment.