Lameire, Norbert

Morton, Rachael L

Van Biesen, Wim

van der Tol, Arjan

Vanholder, Raymond

English

Ghent University Academic Bibliography

Table 1 – Hospital HD unit clinical incident reports from April 2014 to December 2018Clinical incident In-centrenocturnalHD (n=36)ConventionalHD (n=327)Stafﬁng levels 13.9% (5) 2.1% (7)Facilities and infrastructure 19.4% (7) 5.8% (19)Medical device or equipment error 25.0% (9) 17.4% (57)Transport issues 0 3.1% (10)Patient falls 11.1% (4) 12.5% (41)Patient declined haemodialysis 5.6% (2) 25.1% (82)Other 25.0% (9) 33.9% (111)CONCLUSIONS: Patients and staff showed overall satisfaction with INHDprogramme. Starter packs improved patient experience but are not critical toadherence to the programme. Review of the incident reporting did not identify anyspecific safety concerns overnight. INHD programmes should be more widelyavailable.SP680 ASSESSING SYMPTOM ASSESSMENT AND MANAGEMENTPROCESSES FOLLOWING THE ADMINISTRATION OF APATIENT-REPORTED OUTCOME MEASURE TOHEMODIALYSIS PATIENTS IN ONTARIORebecca Lum1, Alysha Glazer1, Marnie Mackinnon1, Esti Heale1, George Torys1,Jane Ip1, Joanie Gingras1, Yingbo Na1, Peter Blake2, Michael Walsh31Ontario Renal Network, Toronto, Canada, 2London Health Sciences Centre, London,Canada and 3McMaster University, Hamilton, CanadaINTRODUCTION: People receiving hemodialysis commonly experience symptomsthat healthcare providers may not routinely assess and/or manage. To address this gapin hemodialysis care, the Ontario Renal Network tested a standardized approach tosymptom screening, assessment, and management using a patient-reported outcomemeasure, the Edmonton Symptom Assessment System Revised: Renal (ESAS-r:Renal).The objective of this study is to assess the results of ESAS-r:Renal administration onsymptom assessment andmanagement processes.METHODS:A total of 1,459 patients from 8 dialysis units in Ontario, Canada wereincluded and completed the ESAS-r:Renal every 4 to 6 weeks. We audited randomlysampled charts, stratified by symptom severity, for six symptoms (anxiety, depression,itching, tiredness, pain, shortness of breath). Data was abstracted on whether thesymptoms were discussed and what management approach was utilized.RESULTS: In total, 1,207 ESAS-r:Renal screens were reviewed between June-August2018. Of these, 66% of screens had a documented assessment conversation (44%weresymptom specific and 22%were general symptom conversations) and 50% had adocumented symptommanagement approach. The proportion of documentedassessment conversations and symptommanagement approaches increased withsymptom severity. Themost common documented symptommanagement approacheswere patient education and lifestyle changes (25%), continuation of ongoinginterventions (24%), newmedications or prescriptions (13%), and referrals to alliedhealth (5%). In 17% of screens, patients declined the symptommanagement approachrecommended by their healthcare provider.CONCLUSIONS:Documented assessment conversations andmanagementapproaches increased with increasingly severe self-reported symptoms on the ESAS-r:Renal. The effects of these conversations andmanagement on patient experience,symptom burden, and health resource utilization require further study.SP681 EFFECT OF INNOVATIVE NON-WEIGHT BEARING EXERCISEDURING HEMODIALYSIS ON DEPRESSION: A RANDOMIZEDCONTROLLED TRIALabdullah hamad1, Bijan Najafi2, He Zhou2, Talal Talal1, Baha El Hag3,Rania Ibrahim1, Mincy Mathew1, Fadwa Alali11Hamad General Hospital, Doha, Qatar, Qatar, 1Hamad General Hospital, Doha, Qatar,2baylor medical college, houston, United States of America and 3hamad general ,Doha, Qatar, QatarINTRODUCTION:Depression affects one third of hemodialysis (HD) patients.Untreated depression could negatively impact physical health, quality of life andoutcomes. Face to face supervised exercise can reduce depression but are hard toachieve in HD patients because of dialysis schedule, post HD fatigue andtransportation. In this study, we examined whether a non-weight bearing (NWB) footand ankle supervised exercise program during hemodialysis session is effective toreduce depression. In addition, we compared supervised exercise with an innovativegamification of the exercise (Exergame) on reducing depression.METHODS: Eighty-one HD adults (age=64.26 8.6 years, BMI=31.46 7.5,female=55.6%) were recruited and randomized (ratio=1:1) into a virtually supervisedexercise group (VSEG: n = 44) or a supervised exercise program (SEG: n = 37). Bothgroups underwent a 4-week NWB ankle and foot exercise program (30-min persession, 2 sessions per week) during HD process. The VSEG received exercise via aninnovative Exergame program, which uses foot-worn sensors enabling them to playgame-like exercise tasks by rotating their feet in dorsiflexion, plantarflexion, orinternal-external rotations. The Exergame platform enables computerized coachingexercise (virtual supervision) and gamification features such as rewarding (audio andvisual) when each exercise task is successfully completed. The SEG received similarNBW foot and ankle exercise. However instead of virtual supervision, the exercise taskswere coached by a nurse and no gamification feature was used except verbalencouragement by the nurse. The effect of exercise on depression was quantified byCenter for Epidemiologic Studies Depression (CES-D) scale.RESULTS: Five subjects in the VSEG and 1 subjects in SEG dropped from the studyeither because of health complication, travelling, or lack of interest. According to theCES-D score, 36% of subjects were depressed before the exercise program. Resultssuggest that both groups had significant reduction in the CED-D score (39% in theVSEG and 43% in the SEG, p<0.001) after 4-week exercise program. Similarlypercentage of depressed patients dropped by approximately 40% irrespective of groupassignment. The effect size of change in depression scale in response to exercise wasslightly larger in the VSEG (Cohen effect size d=0.68 in the VSEG vs. 0.66 in the VSEG),however no significant difference was observed between groups (p=0.165).CONCLUSIONS:Our innovative trial suggests that NWB foot and ankle exercise ispractical during HD process and is effective to reduce depression. Resultsdemonstrated that virtually supervised exercise could be as effective as supervisedexercise to reduce depression. Using virtually supervised exercise improve adherenceand reduce burden of administrating exercise during HD therapy. Results showedslight benefit of gamification provided by computerized exercise but the benefit wasnot significant in our sample.SP682 THE IMPACT OF DIALYSIS MODALITIES ANDREIMBURSEMENT FEES ON PUBLIC HEALTH CAREEXPENDITURE IN EUROPEAN COUNTRIES WITH HIGHERAND LOWER GDPCArjan Van der Tol1, Norbert Lameire1, Rachael L Morton2, Wim Van Biesen1,Raymond Vanholder11Ghent University Hospital, Ghent, Belgium and 2NHMRCCTC, Sydney, AustraliaINTRODUCTION: The high financial burden of provision of dialysis services is morepronounced in poor than rich countries.We compare government reimbursement forhemodialysis (HD) and peritoneal dialysis (PD) in the European countries with thehighest and lowest GDP to assess the impact on the government healthcare budget, anddiscuss strategies to reduce the cost of dialysis.METHODS: Cross-sectional survey of nephrologists conducted online July—December 2016. European countries were divided by the median of GDP per capita(15,870 euro) in 19 richest vs. 19 poorest countries.RESULTS: The prevalence of patients per million population being treated with long-term PDwas higher in the richest vs. the poorest countries (58625 vs. 34621; p=.002)while for chronic HD no difference was found (4876222 vs. 4746191; p=0.97). Thepercentage of PD in the overall dialysis population was higher in the richest vs. thepoorest countries (12.367.0 vs. 7.365.3; p=.007). Only 2 of 38 countries with a PD-first policy had a considerably higher percentage use of PD (both 20%). HD-to-PDreimbursement ratio was higher in the richest vs. the poorest countries (1.5760.83 vs.1.0760.67; p=.007). Home HDwas mainly reimbursed in the richest countries (58 vs.11%, p=.002). The percentage of public health expenditure spent on reimbursement ofdialysis was lower in the richest vs. the poorest countries (0.9660.59 vs. 2.4861.75;p<.001). Themajority of countries had no active policy of CKD screening (76%).CONCLUSIONS: In most countries, government policy is inadequate to increase theuse of cost saving dialysis modalities (e.g. PD, home HD). Economic and politicalmeasures are urgently needed to decrease the financial burden of dialysis services,especially in the poorest European countries where PD is not really cost saving, andwith a disproportionately high impact on public health expenditure.SP683 HEMODINAMIC TOLERANCE TO PHYSICAL EXERCISEINTRADIALISIS THROUGH VIRTUAL REALITYAlicia Garcıa-Testal1, Francisco Jose´ Martınez-Olmos2, Rafael Garcıa Maset1,Ortega Pe´rez De Villar Lucıa2, Jose´ Antonio Gil-Gomez3, David Hervas Marın4,Pilar Royo Maicas1, Inmaculada Rico Salvador1, Laura Lahoz Cano1, Victor LopezTercero1, Caterina Benedito Carrera1, Eva Segura-Ortı21Hospital de Manises, Manises, Spain, 2Universidad CEU Cardenal Herrera - CampusMoncada, Moncada, Spain, 3UPV, Vale`ncia, Spain and 4Instituto de InvestigacionSanitaria La Fe, Vale`ncia, SpainINTRODUCTION: Physical exercise (EX) using non-immersive virtual reality (VR) isa novel method of rehabilitation for patients undergoing hemodialysis (HD)i584 | AbstractsAbstracts Nephrology Dialysis TransplantationDownloaded from https://academic.oup.com/ndt/article-abstract/34/Supplement_1/gfz103.SP682/5515600 by Ghent University user on 06 January 2020

The impact of dialysis modalities and reimbursement fees on public health care expenditure in European countries with higher and lower GDPC

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The impact of dialysis modalities and reimbursement fees on public health care expenditure in European countries with higher and lower GDPC

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