S 14 Parallel Session

Abstracts

GUEST SPEAKER
Technology-related clinical risks and problems in haemodialysis
F. Lopot^1
1General University Hospital and Charles University Medical School, Prague, Czech Republic

Extracorporeal blood cleansing procedures are on one side life-saving, but on the other side they bear significant risks and hazards when that technology is not applied with appropriate knowledge and caution. “Technolgically-conditioned” are different adverse events associated with blood loss in the extracorporal circuit (clotting as a consequence of improper priming procedure, failure to adequately anticoagulate the circuit etc or haemolysis from mechanical or chemical reasons) or loss of blood into environment (membrane rupture, needle dislodgement, disconnection of the extracorporeal circuit). Potentially fatal is air embolism caused by failure of the respective detector(s) or erroneous reaction of the staff to alarm situations. Also risk of transmission of infectious diseases between patients are associated with the extracorporeal blood circuit rather than by the hydraulic pathway of the dialysis machine. Typical clinical problems attributable to dysfunctional dialysate circuit or its improper handling include sodium dysbalance which may bet manifested both intradiaalytically (crapms) or during the interdialytic period (increased interdialytic weight gains) and positive thermal balance which may induce or contribute to intradialytic hypotension onset. Quite hazardous is high or too fast alkalisation of the patient which may even result in sudden cardiac arrest. One has to be aware that intradialytic changes in plasma pH are related not only to bicarbonate content in dialysis solution but also to the content of bicarbonate precursors in it used as its acidifying agents (both acetate and and today also increasingly used citrate). Specific risks usually not considered at all by dialysis staff are given electric currents leaking from faulty machine via the patient to ground. This is especially an issue in patients dialysed via central venous catheters.

BIOGRAPHY OF THE GUEST SPEAKER

O 22

Impact of dialysis solution(DS) bicarbonate(HCO3-) and calcium(Ca2+) concentration on patient plasma ionized calcium(Ca2+) concentration
S. Vankova¹ , M. Halaszova^1
1Dialysisi Unit, BBraun Avitum, Prague, Czech Republic

Background: Haemodialysis with low-calcium DS(Ca2+1.25 mmol) increases sudden death risk, and QTc dispersion. Nothing is known about intradialytic changes in plasma Ca2+ with respect to concentration of HCO3- in DS. Moreover, low Ca2+in DS is recommended as extraosseal calcifications prevention.
Objectives: We assume that content of Ca2+ and HCO3- are important factors having an impact on resulting Ca2+plasma concentration.
Methods: We examined 11 patients with sinus rhythm, uncomplicated dialyses proceeded. Shunt function was 350 ml/min, recirculation under 4%. Each patient underwent 4 treatments with the following parameters: HD 4.5hours, QB 350ml/min, QD 600ml/min, dialyser polysulfone, low flux 1.5m2. Concentrations of Ca2+ and HCO3- were changed gradually: A/ HCO3-26, Ca2+1.25  B/ HCO3-32, Ca2+1.25  C/ HCO3-26, Ca2+1.5    D/ HCO3-32, Ca2+1.5. Before/after HD we monitored: Ca, Ca2+, HCO3-, ECG. For statistic we used ANOVA-test.
Results: ECG recorded neither any arrhythmia nor any QTc interval changes.Intradialytic Ca2+changes were 0,03mmol/l for DS1,25/26, -0,02mmol/l for for DS1,25/32, 0,14mmol/l for for DS1,5/26 and 0,18mmol/l for forDS 1,5/32. Ca2+ changes were significant for different Ca-concentrations and for combination of different HCO3 and Ca-concentrations.
Conclusion/Application to practice: Post-dialysis plasma Ca2+concentration is affected significantly not only by DS-Ca2+concentration but also by combination of HCO3- and Ca2+. Intradialytic alkalinisation may be risk factor for reduction of biologically active plasma calcium. We failed to prove any ECG changes.

Disclosure: No conflict of interest declared

O 23
Intensive patient bedside education as a path towards better compliance in protein supplements intake
B. Poje¹, S. Vidrih¹, V. Babić¹, N. Kalinić¹, F. Šimunović¹, B. Vujičić¹, S. Rački^1
1Nephrology and Dialysis, KBC Rijeka, Rijeka, Croatia

Background: Malnutrition is common in dialysis patients. It predicts morbidity and mortality both in hemodialysis and peritoneal dialysis. Hence, nutritional supplements are routinely suggested to such patients to maintain  their nutritional status. However non-compliance is common among this group. To standardize therapy and improve the clinical outcome for our chronic hemodialysis (HD) patients, we evaluated compliance between the oral protein supplements prescribed and what the patients are really taking.
Methods: All patients (135) on hemodialysis were eligible for the study. We analyzed the initial compliance evaluation before our intense bedside education and repeated the evaluation three months later. At the first evaluation we analyzed data from 105 patients who were given protein supplement. From that number only 50 (47%) patients took their supplement regularly. 65 (58%) gave indigestion as the main reason for not complying.  52 (80%) and 13 (20%) of patients gave no reason for not complying. In the follow up evaluation three months later we had 112 prescribed supplements. 100 (89%) patients fully complied and only 12 (10%) patients failed to comply. Of those who failed to comply  8 (66%) gave indigestion as the main reason and 4 (34%) gave no particular reason.
Conclusion/Application to practice:Our study showed significant reduction in non compliance after the intensive bedside education provided by our nurses.

Disclosure: No conflict of interest declared

O 24
Analysis of the nutritional status of patients with renal disease during hospitalization
C. Hidalgo López¹, M. Fernández Chamarro¹, S. Collado Nieto¹, G. Garcia Gallardo¹, M.T. Baz Fernández¹, E. Junyent Iglesias^1
1Nephrology , Hospital del Mar, Barcelona, Spain

Background: Prevalence of malnutrition in our population is very high, 57.6% of our patients had an albumin <3.5 at the time of discharge. Is an important common problem and a risk factor for mortality, there is no consensus for evaluation.
The use of bioimpedance (BIA) has been extended recently, is an objective method, safe and low cost to assess body composition and hydration status, can obtain nutritional parameters.
Objectives: Assess the nutritional impact of hospitalization. Record and analyze the percentage of daily dietary intake during admission. Assess if BIA is related to other nutritional parameters.
Methods: Prospective observational study of patients admitted to our nephrology ward for 6 months. Analytical analysis and anthropometric parameters: albumin, Subjective Global Assessment (SGA), Simplified Nutritional Appetite Questionnaire (SNAQ) and BIA at admission and at discharge. We made a record of the daily intake of the sample.
Statistical analysis SPSS 20.
Results:92 patients were included with a mean age of 61.4±20.5 years, a BMI of 28.6±7.3 kg/m2 and a mean hospital stay of 11.79±7.78 days. 

Intakes were assessed, missed meals by fasting for additional tests were recorded.
Breaking down the SNAQ questions at discharge we found the level of appetite and how does the food tastes to our patients.
Patients with an albumin <3.5 had a >FTI and those with an albumin >3.5 a
Conclusion/Application to practice: Hospitalized patients lose between 10% -17% of the meals; we have started raising interventions to reduce that amount. Many meals are lost by fasting and often are not recovered.

Disclosure: No conflict of interest declared

O 25
Long nocturnal dialysis - A better quality of life?
C. Gonçalves¹, F. Leandro¹, B. Pinto¹, F. Gomes¹, D. Navarro¹, J. Fazendeiro Matos², M.T. Parisotto^3
1NephroCare Dialysis Centren VFXira, Fresenius Medical Care, VFXira, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; ³NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: The Long Nocturnal Dialysis programme (LND) launched in April 2013 was developed to meet the requirements of a well-tolerated, effective, and affordable treatment, reduce morbidity and mortality of patients thus increasing their quality of life (QOL).
Objectives: To compare QOL aspects before and after initiation of LND.

Methods: We evaluated 12 patients (three female, mean age 41.55 ± 6.93 years) with a mean time on HD of 63 ± 37.2 months. Patients were surveyed before and after LND implementation with the following self-administered questionnaire: KDQOL-SF version 1.3 adapted to our objectives and validated by a pre-test.
Results: From the results we highlighted the ones with statistical significance (p <0.05). Comparing mean scores of QoL aspects before LND vs. after LND implementation revealed:
• Perception of their health improved from 2.5 (±1.17) to 3.4 (±1.16) on average
• Perception of breathlessness decreased from 2.42 (±2.42) to 1.42 (±0.79) on average
• Anorexia, decreased from 2.01 (±1.38) to 1.33 (±0.65) on average
• Perception of fatigue decreased from 3.5 (±1.01) to 2.33 (±1.30) on average
• Perception of satisfaction with the amount of time spent with family and friends, increased from 2.92 (±1.08) to 3.83 (±1.19) on average
Conclusion/Application to practice: Of 20 parameters analysed only five had statistical significance although improvements were observed in all of them. We can thus conclude that there was indeed an improvement in the patients’ QOL.

Disclosure: No conflict of interest declared

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