8R - Research Paper

Abstract
Aim:
To investigate the health profile of a cohort of people receiving HD in Sri Lanka and to identify factors associated with interdialytic weight gain (IDWG).

Method:
Cross-sectional study of 166 adults receiving haemodialysis. A structured chart audit form collected demographic and HD treatment characteristics, and recent biochemical and haematological results. Odds ratios were calculated to identify independent risk factors for IDWG.

Results:
Mean age was 52 years (SD = 12.5), over half were male (60.2%, n = 100), and most were receiving four hours of HD once per week (87.3%, n = 145). Approximately half (51.8%, n = 86) had an IDWG > 2%. Being female (OR = 3.39; 95% CI, 1.51–7.61), increased comorbidities (OR = 1.50; 95% CI, 1.22 – 1.84) and having body mass index outside of the normal range (overweight/obese [OR = 8.49; 95% CI, 3.58–20.13] or underweight [OR = 4.61; 95% CI, 1.39–15.31) were independent risk factors for increased IDWG.

Conclusion:
Only modest alterations in potassium, phosphate, and fluid status were observed even though most patients were receiving four hours of HD once per week. Targeted, low-cost self-management interventions for ‘at risk’ groups could reduce the consequences of inadequate HD during times of war, climate, or financial challenges. 

497C - Research Paper

Abstract
Case Description:
This is a case of 36-year-old man with a past medical history of Systemic lupus erythematosus, which was diagnosed in 2011 and later flared up in 2015 leading to a number of complications such as pancytopenia and thrombolytic microangiopathy. They were treated with plasma exchange, Intravenous immune globulin, IV cyclophosphamide, rituximab and eculizumab. Creatinine was 228 mmol/l, eGFR 32 ml/min/1.73m2 and platelet count was 142 x 109/L. In 2017, they later developed fatty liver disease and subclinical hypothyroidism. Creatinine and eGFR improved to 189 mmol/l and 40 ml/min/1.73m2 respectively. In 2021, they had another flare up requiring plasma exchange and eGFR continued to deteriorate. In 2023, hemodialysis was started using a permcath.

Description:
Successful management of this patient required collaboration across multiple disciplines such nephrology, haematology, neurology, infectious diseases and nursing. Medical management involved innovative treatment approaches which required regular monitoring and intervention. Most importantly, the patient and caregiver involvement was crucial when navigating complex healthcare settings. Even though the patient was known in the hospital system for over 10 years, they started dialysis with a permcath. Reasons for this include the competing needs in managing this complex condition. 

Conclusion:
Effective collaboration among healthcare professionals is crucial when managing patients with complex diagnoses. Participation of patients and caregivers need to be promoted. 

434R - Research Paper

Abstract
Aim:
To evaluate the feasibility of an intervention to improve health literacy, self-management and fluid adherence in adults receiving HD

Method:
A pragmatic, cluster, randomised control feasibility trial involving adults on HD for at least 3 months. Control group participants received standard care with the intervention group receiving standard care plus a 12-week self-management education program. The intervention included four face-to-face individual teach-back sessions and health education by a registered nurse. Primary outcomes were feasibility of participant recruitment, completion rates of patient-reported outcome measures (PROM), and retention rate.

Results:
The study recruitment rate was 53.2% (50/94 screened). Fifty participants (mean age 52 years) were randomly allocated to intervention (n = 25) and control groups (n = 25). Overall PROM completion rates at baseline and 12 weeks were 88% and 90% respectively. After 12 weeks, retention rates for the intervention and control groups were 96% and 92% respectively.

Conclusion:
The successful recruitment and retention of participants suggest that the intervention is feasible to deliver in the clinical setting during HD treatment for people with varying health literacy abilities. Evidence from this study will inform the design of a larger efficacy trial. 

483R - Research Paper

Abstract
Aim:
The review aims to examine the existing literature for haemodialysis water conservation practices globally. Providing a range of practical examples of water conservation approaches and their cost-effectiveness may encourage more sustainable haemodialysis in homes and in-patient settings. 

Method:
PubMed and Embase databases were searched in March and October 2022. An expert in the field was also consulted to provide additional articles not captured in these searches. Using PRISMA guidelines, several researchers screened abstracts to include 25 articles. Eligible studies discussed water conservation methods in haemodialysis across different sites. All study types including personal statements were included. Non-English articles were excluded.   

Results:
The review highlighted various water conservation strategies. It discussed reusing Reverse Osmosis Reject Water (RORW) for sanitation, sterilization, and irrigation purposes. Additionally, it explored reducing overall water production, reusing post-dialysis effluent, and innovating haemodialysis unit designs. While financial benefits may be limited presently, these approaches offered potential long-term advantages. 

Conclusion:
RORW, a valuable yet underutilized resource, holds promise for greywater use. Repurposing it for sanitation and sterilization is sustainable and cost-effective. Although further research is needed for its use in agricultural irrigation, adopting sustainable water approaches in haemodialysis is crucial to combat present water scarcity.