New findings demonstrating positive outcomes related to seven days a week dialysis services were presented Nov. 4 at the American Society of Nephrology’s Kidney Week 2017 in New Orleans. The research was conducted by a group of nephrologists from Centro Brasiliense de Nefrologia & Dialise (CBN&D), Brazil.
This abstract entitled “Seven Days a Week Dialysis Service to Achieve an Effective In-Center Short Daily Hemodialysis Program” and prepared by Pedro Pascoal, Adolfo Simon, Kelia Xavier, Vilber Bello, Juliane Lauar and Istenio Pascoal examines the 10-year impact of the seven-day availability on patient schedule and compliance as well as on hospitalization and survival rates on their 160 short daily in-center hemodialysis patients.
“In-center hemodialysis programs usually operate Monday through Saturday, in two conventional thrice-weekly schedules: Mon-Wed-Fri or Tue-Thu-Sat. On Sundays, in the midst of the long 72-hour interval, dialysis centers are regularly closed and patient care relies on emergency rooms, leading to concerns of higher mortality over weekends” said Pedro Pascoal the presenting author
After setting up a 6 days a week in-center short daily hemodialysis program, they started to provide dialysis treatments also on Sundays. One hundred and sixty consecutive unselected patients receiving in-center short daily hemodialysis treatments – 6 to 7 times/week, lasting 2 hours with ultrapure dialysate and single-use highflux dialyzer, were studied.
“By introducing seven days a week dialysis service for our short daily hemodialysis patients, we have given them the option of really daily dialysis with no breaks – seven days a week, or the freedom of choosing any day-off other than Sunday – six day a week , or the opportunity of replacing, on Sundays, eventual missed treatment occurring in their original Monday to Saturday schedule. On average, 30% of our patients attend our Sunday dialysis program,” said Dr. Juliane Lauar, CBN&D Medical Director.
Prior studies from multiple fields have demonstrated that hospital admission on the weekend is associated with poorer patient outcomes, the authors said.
“Seven-day dialysis services may well narrow the gap between weekday and weekend dialysis mortality, as supported by our consistently low hospitalization and mortality rates” said Pedro Pascoal.
From June 2007 to May 2017, 24 out of 160 (15%) their cumulative short daily hemodialysis patients extended their schedule from 6 to 7 treatments per week, 9 (6%) chose Saturdays as their regular day-off, and the remained 127 (79%) have occasionally dialyzed on Sundays to replace most of the missed treatment occurring in their original track.
Over the 10-year study period, the average missed treatment rate was 1.47% or 4.5 days per patient-year and the hospitalization rate was 0.4 admissions per patient-year. In parallel, the 5-year cumulative patient survival rates were 98%, 92%, 82%, 69% and 60% at 12, 24, 36, 48 and 60 mo, respectively.
“From an economic point of view, extra dialysis treatments delivered to our patients who extended their schedule from 6 to 7 times a week (2.25%) exceed the residual missed treatment rate (1.47%), and has allowed our Sunday dialysis to become, from concept to practice, a self-sustaining program”, said Dr. Istenio Pascoal, nephrologist and CBN&D CEO. “We are excited to be sharing this data with the entire renal care community. Altogether, this Sunday dialysis program has been a convenient, protective and economically viable initiative.”