#960 A single-centre service evaluation of patient-centred twice-weekly dialysis delivery

Abstract Background and Aims Many individuals receive twice-weekly haemodialysis with an aim to increase dialysis frequency or as a step towards withdrawing renal replacement therapy. We aim to describe a cohort of individuals who receive long term twice-weekly haemodialysis in a single centre and compare their clinical outcomes, quality of life (QoL) measures and dialysis efficacy with a matched group receiving thrice-weekly dialysis in the same centre. Method In this centre with 110 haemodialysis patients, 16.3% receive twice-weekly dialysis. 15 twice-weekly patients were matched by age and sex with 26 patients on thrice-weekly dialysis. Data on biochemical parameters, dialysis adequacy and hospital admissions were retrospectively collected for a 12-month period from electronic patient records and IPOS-Renal QoL questionnaires were collected for service evaluation. Results Twice-weekly (n = 15) and thrice-weekly (n = 26) groups were of comparable Charlson Comorbidity index (6.87 vs. 7.04). The Edmonton Frailty Scale was higher in the thrice-weekly group (mean= 7.1 vs. 5.8). Median dialysis vintage in the twice- and thrice-weekly groups were 37 months (Q1–Q3 = 59) and 37 months (Q1–Q3 = 45) respectively. One third of the twice-weekly group had reduced the number of days since commencing dialysis. This subgroup had spent approximately half (54.2%) of their time on dialysis receiving twice-weekly treatment. Thrice-weekly patients received a mean 11.28 (±1.47) hours/week of haemodialysis, compared to 6.91 (±1.26) hours/week in the twice-weekly cohort. Haemoglobin and potassium levels remained within safe parameters in the twice-weekly cohort with a mean Kt/V of 1.46 (±0.31) (Fig. 1). In a single 24-hour urine collection, the twice-weekly patients had greater urinary volumes [0.87 (0.64) vs. 0.37 (0.62) L/24 hrs, median (Q1–Q3)]. The thrice-weekly patients had more than double the number of hospital presentations in the study year (4.54 vs. 2.13, per person-year). The greatest cause for presentation was infection in both groups (44% vs. 43%) (Table 1). More of the thrice-weekly group reported itching, sore or dry mouth and poor appetite. However, fewer of this group reported shortness of breath and drowsiness (Fig. 2). Reporting of psychological symptoms did not appear to differ between the groups. More of the thrice-weekly group reported that practical problems from their illness had not been addressed (50% vs. 20%), and that up to, or more than half of their day is wasted on healthcare appointments (45% vs. 10%). Conclusion We observed comparable dialysis safety and adequacy in twice- and thrice-weekly haemodialysis patients matched for age and sex. The twice-weekly population were less frail, had fewer hospital presentations and reported better QoL in some domains. This supports the hypothesis that in carefully selected individuals, long-term twice-weekly haemodialysis schedules may be safe, and potentially beneficial. In a dialysis population that is increasingly old and frail, person-centred care becomes even more paramount. Tailoring haemodialysis prescription to meet shared goals of care may improve QoL of older people treated with haemodialysis. Further work must identify more clearly which patients could be offered twice-weekly dialysis without risk of adverse outcomes.

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