S 15 Parallel Session

Title: Predialysis – prevention
Sunday, September 7, 16:00 – 17:30
Omega 1

Programme of the session:

GS: Philip Kalra
Optimising the care of the pre-dialysis patient

O 26
Preparing patients to choose a renal replacement therapy: experiences and practical suggestions
Tony Goovaerts (Belgium)

O 27
Healing by design – developing partnership with architects in dialysis unit design
Samuel M. Sedgewick (UK)

O 28
Assessing the impact of educational intervention in hypertensive patients
Tai Mooi Ho (Spain)

O 29
The impact of exercise on haemodialysis patients’ quality of life – A systematic review
Pedro Martins (Portugal)

Abstracts:

GUEST SPEAKER

Abstract is not available

BIOGRAPHY OF THE GUEST SPEAKER

O 26
Preparing patients to choose a renal replacement therapy: experiences and practical suggestions
T. Goovaerts¹, C. Isnard Bagnis², C. Crepaldi³, J. Dean⁴, S. Melander⁵, A. Mooney⁶, M. Prieto-Velasco⁷, C. Trujillo⁸, R. Zambon³, E.L. Nilsson^9
1Cliniques Universitaires St. Luc, Service de Néphrologie, Brussels, Belgium; ²Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière et Chaire de Recherche en Education Thérapeutique, Université Pierre et Marie Curie, Paris, France; ³Unità Operativa di Nefrologia, Dialisi e Trapianto, Vicenza, Italy; ⁴Department of Clinical Health Psychology, Salford Royal Hospital, Salford, United Kingdom; ⁵Department of Nephrology, University Hospital of Linköping, Linköping, Sweden; ⁶Renal Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; ⁷Unidad de Nefrología, Complejo Asistencial Universitario de León, León, Spain; ⁸Unidad clínica de Gestión de Nefrología, Hospital Regional Carlos Haya, Malaga, Spain; ⁹Department of Nephrology, Skånes University Hospital, Malmö, Sweden

Background: Different treatment modalities are available for patients with progressive chronic kidney disease. The choice of modality may have a significant impact on patient satisfaction with care, compliance with therapy and ultimately treatment outcomes. Therefore, active patient involvement in the choice of treatment is crucial to maintain his/her engagement in the therapy.
To help patients make an informed choice, guidelines recommend a programme of Renal Replacement Therapy Option Education (RRTOE), but with little guidance on its content, delivery and assessment. Nurses are key players in organising, delivering and
assessing RRTOE.
Methods:A panel of ten European experts was gathered to share their experience and build a consensus on quality standards and practical advice to support nurses in providing effective, unbiased and individualised RRTOE.
Results: The following were identified as indicators of good RRTOE programmes: (i) a multidisciplinary team, with a nurse and a nephrologist as core members; (ii) an experienced nurse, ideally in all treatment modalities, with communication skills that maximise the patient’s learning and avoid bias; (iii) an individualised approach, that consists in engaging with the patient and adapting RRTOE to his/her needs in terms of session types (one-to-one vs. group sessions, visits to dialysis units, meetings with expert patients), material selection (booklets, videos) and content structure (appropriate timing); (iv) a continuous improvement feedback loop, including a series of quality assessment criteria in line with the RRTOE objectives.
A field survey will be performed in the coming months to evaluate the extent to which dialysis clinics already comply with these indicators.

Disclosure: All authors have served as consultants to Baxter Healthcare Corporation. M.P.-V. has advised, consulted or received speaker honoraria from Baxter, Fresenius, Gambro, Abbvie, Shire, and Sanofi Renal. A.M. is on the speaker list for Sanofi, BMS, MSD, Shire, Amgen and Pfizer. T.G. has served as a consultant to Gambro AB, Fresenius, and Amgen.

O 27
Healing by design – developing partnership with architects in dialysis unit design
S.M. Sedgewick¹, P. Jones¹, J.M. Sedgewick^2
1School of Architecture & the Built Environment, Northumbria University Newcastle, Newcastle, United Kingdom; ²Nursing Education, King Faisal Specialist Hospital & Research, Jeddah, Saudi Arabia

Background: Healing by design considers how architecture promotes healing and how research evidence and best practice guides innovative design solutions. The philosophy of healing by design is well documented although its application to dialysis unit design has been limited.
Objectives: This study, part of a Master’s degree in Architecture, investigated architectural design of dialysis units and its environmental impact upon patient and staff.
Methods: Using mixed methods design, data collection included observational field visits to dialysis units within Europe, focus group with representatives of patient association and an electronic survey of EDTNA/ERCA members concerning dialysis unit design. Global opinion leaders within the fields of nephrology & architecture also contributed to the data collected.
Results: Patients felt strongly that dialysis unit design increased their feelings of being institutionalised and detached from the outside world which worsened their feelings of depression. From the 13 environmental factors examined within the survey, EDTNA/ERCA respondents were least satisfied with dialysis unit levels of privacy, views from windows, unit temperature & unit odour. Improved ‘patient privacy’ was believed to be the single most important factor with representatives from the patients association suggesting improved privacy would have the biggest impact on patient well-being.
Conclusion/Application to practice: Collaboration between patients, renal healthcare professionals, patients and architects in implementing thoughtful architecture on dialysis unit design is vital in acknowledging how light, colour, space and design effects patient and staff well-being, patient privacy, dignity, and quality of life. The findings from this study have been used to guide the design and development of a prototype renal unit.

Disclosure: No conflict of interest declared

O 28
Assessing the impact of educational intervention in hypertensive patients
T.M. Ho¹, D. Estrada², J.P. Agudo³, P. Arias⁴, R. Capillas⁵, E. Gibert⁶, M.M. Isnard⁷, M.J. Solé⁸, A. Salvadó^9
1Servei de Nefrologia, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain; ²Servei de Medicina Interna, Hospital Clínic, Barcelona, Spain; ³Centre d’Atenció Primària La Mina, Institut Català de la Salut, Barcelona, Spain; ⁴Servei de Nefrologia, Fundació Puigvert, Barcelona, Spain; ⁵Equip d’Atenció Primària Sant Josep-Hospitalet de Llobregat, Institut Català de Salut, Barcelona, Spain; ⁶Equip d’Atenció Primària Gòtic, Institut Català de Salut, Barcelona, Spain; ⁷Equip d’Atenció Primària Masnou-Alella, Institut Català de Salut, Barcelona, Spain; ⁸Servei de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; ⁹Centre d’Atenció Primària La Sagrera, Institut Català de Salut, Barcelona, Spain

Background: It is accepted that patient education can be beneficial in the treatment of chronic diseases. We conducted an educational intervention (EI) in hypertensive patients seen at Primary Care centres (PCC) and specialised Hypertension Units (SHU).
Objectives:To assess patient's knowledge of hypertension and to verify the impact of this educational initiative.
Methods: A multicentre quasi-experimental study with the participation of 120 hypertensive patients. EI consisted of oral and written information which included the definition of hypertension, causes, cardiovascular risk factors and means of control. A self-administered questionnaire was used to assess patient's knowledge before and after EI.
Results:62 (52%) patients were from PCC and 58 (48%) from SHU (mean age: 61 ±13.3 years, 59% were women). There were no differences in baseline characteristics between patients attended at PCC and SHU. The definition of hypertension (blood pressure ≥140mmHg and/or ≥90mmHg) was known by 48% and 99% of the participants before and after EI, respectively (p <0.001). Poor baseline knowledge about the risks of hypertension was related to kidneys (54%) and eyes (58%). After EI this knowledge increased to 100% (p <0.001 and p <0.001, respectively). A significant improvement in knowledge about medication was observed (51% before and 87% after EI; p=0.004). 
Conclusion/Application to practice: This study shows positive impact of EI to improve patients' knowledge about hypertension. However, further studies are needed to assess if EI produces behaviour changes in the long term, as this may enhance optimal blood pressure control to prevent kidney disease or dalay its progression.

Disclosure: No conflict of interest declared

O 29
The impact of exercise on haemodialysis patients’ quality of life - A systematic review
R. Camisa¹, P. Martins¹, A. Seabra¹, J. Fazendeiro Matos², M.T. Parisotto^3
1NephroCare Dialysis Centre Coimbra, Fresenius Medical Care, Coimbra, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; ³NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: Literature shows that the incorporation of moderate physical activity is particularly beneficial for people with chronic kidney disease (CKD). However, the positive impact of intradialytic exercise on patients’ quality of life (QoL) has not been established yet.
Objectives: To assess whether literature provides scientific evidence that exercise for haemodialysis patients is effective in improving their quality of life
Methods: A systematic review was performed to answer the question: ”Is exercise in haemodialysis patients a way to improve their quality of life?” We searched on EBSCOhost and Google Scholar. The criteria excluded were: Paediatric population, peritoneal dialysis, and studies older than 2005.
Results:We found six studies and one systematic review: Four about intradialytic exercise, one about prior dialysis exercise and one about exercise on non-dialysis days. The systematic review included two studies of intradialytic exercise, one about prior and during dialysis exercise and one with home independent exercise and intradialytic exercise.
Conclusion/Application to practice: All analysed studies, except for one, suggested a positive correlation between exercise intervention and the QoL of patients with CKD. The implementation of a training programme showed significant improvements in physical, social, and mental health dimensions.
More studies are required to determine the best exercise programmes to improve quality of life. According to the results in literature we will develop a randomized controlled trial. This study will assess the effects of an intradialytic exercise programme during the first two hours of treatment on quality of life, physical functioning, and dialysis efficacy of patients.

Disclosure: No conflict of interest declared

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