NKF 2014 Spring Clinical Meetings Abstracts

VARIABILITY IN DIALYSATE SODIUM CONCENTRATION AND ITS EFFECT ON SERUM SODIUM LEVELS. Alexander Osei-Bonsu, Vanya Grover, Adebayo Adewale, Chelsea Estrada, Mersema Abate, Troy Dixon, Nand K. Wadhwa, Leonard A. Arbeit. Division of Nephrology, SUNY, Stony Brook, New York, USA. Current hemodialysis (HD) prescriptions use standard dialysate sodium (Na) concentrations that are relatively elevated compared to the patient’s serum Na, leading to less Na loss and higher post HD serum Na. This predisposes patients to chronic volume overload and hypertension. Dialysate Na individualization for each patient is needed to manage chronic volume overload. We investigated whether the standard dialysate concentration set at 140 mEq/L is delivered consistently with all HD machines to all patients and its effect on pre and post HD serum Na levels. We measured pre HD dialysate Na (NaturaLyte 4000), and pre and post serum Na in 97 chronic stable ESRD patients receiving HD with 28 Phoenix HD machines at our dialysis center. Data are presented as mean + SD. The mean dialysate Na was 140.8 + 1.8 mEq/L ranging from 134 to 146 mEq/L. Dialysis Na was at goal of 140 mEq/L only in 26.8% (26/97) of the samples. Mean post HD serum Na of 139.3 + 1.7 mEq/L was significantly (p<0.0001) higher than mean pre HD serum Na of 137.6 + 2.9 mEq/L. A significant positive correlation was observed between dialysate Na and post HD serum Na (r=0.3, p=0.0007). On an average the post HD serum Na increased by 0.3 mEq/L for each mEq/L increase in the dialysate Na. The data suggest that we need a superior method to guarantee that dialysate Na is equal to the set point dialed in on the machine. Once this occurs we can manage patients with individualized dialysate Na. Dialysis Na based on the pre HD serum Na may result in better management of interdialytic weight gain, chronic volume overload and hypertension in HD patients.

QUALITATIVE EVALUATION OF A PATIENT SELF-MANAGEMENT KIOSK USE IN ADVANCED CHRONIC KIDNEY DISEASE (CKD) FOR A 3-YEAR PERIOD Stephanie Ong, Kelly Min, Eveline Porter, Vanita Jassal, Alexander Logan, Judith Miller, University Health Network, Toronto, ON, Canada Implemented at a multidisciplinary renal clinic in Toronto, the My KidneyCare kiosk is a web-based self-management application that educates patients about CKD, helps patients monitor their progress, engages them to set goals, and provides an interactive tool for collaborating with clinicians. The following discusses benefits and challenges of using the kiosk in ambulatory CKD care to better accommodate patients and promote their self-management care. This project involved a qualitative study to evaluate the feasibility of a kiosk through: 1) survey for patients and providers; 2) retrospective analysis of kiosk use during a three-year period (January 2011 to October 2013); and 3) direct participant observation of the kiosk user experience. User survey results indicated patients (n=56) and providers (n=5) felt that the kiosk added quality to the visit and strengthened the patient-provider relationship. Responses to kiosk use showed 48% of patients did not want to see any other clinicians than the doctor, while 32% of them wanted to see a dietitian. Challenges identified include the lack of integration to the hospital electronic medical record (EMR) system, high dependency on the clinic receptionist to encourage kiosk use, and the change in workflow causing increased workload for staff and increase in patient wait time. Some limitations have affected both patient and provider adoption and are being addressed in updates to enhance the system’s feasibility. Recommendations include formal cognitive workflow analysis of renal clinic to streamline integration, including incorporation of mobile devices to reduce dependence on the kiosk receptionist and enhance convenience in ambulatory clinics.

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BURDEN OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD): EFFECTS ON THE DAILY LIVES OF PATIENTS AND THEIR CAREGIVERS Andrew C Palsgrove,1 Lisa M Guay-Woodford,2 Rebecca Cheng,1 Dorothee Oberdhan,3 Jaime Blais,3 Jason C Cole,1 and Arlene B Chapman.4 1Covance Inc, Gaithersburg, MD; 2Children’s National Health System, Washington, DC; 3Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, MD; 4Emory University, Atlanta, GA. ADPKD leads to kidney enlargement and worsening kidney function due to cyst development and expansion. Patients with ADPKD typically require increased medical care due to kidney infections, stones, pain, and other renal complications as well as lifelong lifestyle modifications. Separate focus groups were held with adult ADPKD patients (n=286) and with caregivers of children and/or adults with ADPKD (n=139) across Europe, North America, South America, Australia, and Asia. Patient focus groups were usually separated by gender; discussions centered around disease burden and impact of ADPKD on patients’ daily lives. Caregivers were asked how caring for an ADPKD patient impacts their own lives. Some caregivers also had ADPKD themselves. Patients and caregivers noted substantial impact on their daily lives due to ADPKD. Patients reported fatigue, physical limitations, and urinary urgency, frequency, and nocturia, as well as emotional impact including anxiety and guilt. Patients also reported three distinct pain types (chronic dull, acute sharp, and discomfort/fullness). Caregivers experience logistical burden with an impact on their social life related to caring for an affected individual (especially those in later stage disease), lost productivity at work and reduced sleep. Caregivers with ADPKD themselves often expressed guilt for passing the disease on to their offspring. ADPKD imposes unique burden on patients and caregivers, with varying degrees of societal, physical, and emotional impact.

CHARACTERISTICS OF INSURED AND UNINSURED INCIDENT ESRD PATIENTS Nilgun Ozturk, William Torres, Balavenkatesh Kanna, Isaiarasi Gnanasekaran, Lincoln Medical Center, Bronx, NY, USA. Lack of insurance is an independent risk factor for ESRD and early death. Our study aims to evaluate the differences between insured and uninsured newly diagnosed ESRD patients at the time of initiation of hemodialysis (HD) in an inner city hospital based HD unit serving minority individuals. Data was collected from the 2728 form and electronic medical record from 1999-2010. Characteristics of insured and the uninsured patients were compared. Adjusted multivariate analysis was performed using logistic regression. 551 patients met the study criteria of which 425 (77%) had insurance and 126 were uninsured. About 60% were Hispanics. In the insured group, there were more female (49 % vs 35%);more older subjects (mean age- 61.4 vs. 48.4 years); more were obese (28% had BMI >30% vs. 13%) and had higher GFR at initiation of HD (7.1 vs. 4.8 ml/min/1.73m2). Adjusted multivariate analysis showed that insured patients had greater odds of being older (OR 1.04, 95% CI 1.02-1.05, p=0.0000), women (OR 1.63, 95%CI 1.05-2.50, p=0.028), and obese (OR= 1.04, 95%CI 1.01-2.15, p=0.02). There were no differences in ethnicity and etiology of ESRD (Diabetes, Hypertensive, Glomerulonephritis and others) between the 2 groups. Among minority ESRD patients at the time of initiation of HD, young men seem to be at greater risk of lacking health insurance. Services should be geared to identify barriers to health coverage and assist these individuals at high risk.

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Am J Kidney Dis. 2014;63(5):A1-A121