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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 288-290
Time loss and quality of dialysis treatment


Renal Department, General Hospital of Komotini, Antoni Rossidi 11, 69100 - Komotini, Greece

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How to cite this article:
Mavromatidis K, Giaramazidou T, Giovreki A, Giangoglou V, Babidou E. Time loss and quality of dialysis treatment. Saudi J Kidney Dis Transpl 2009;20:288-90

How to cite this URL:
Mavromatidis K, Giaramazidou T, Giovreki A, Giangoglou V, Babidou E. Time loss and quality of dialysis treatment. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2014 Oct 31];20:288-90. Available from: http://www.sjkdt.org/text.asp?2009/20/2/288/45582
To the Editor,

The duration and quality of the dialysis pro­vided to patients with end-stage renal disease (ESRD) are of particular importance for their quality of life as well as their survival. [1],[2],[3],[4],[5] We studied prospectively the compliance of patients according to the doctors' prescriptions, for dia­lysis duration in the interval of two independent months (February, June), in order to observe whether there is a variance between them as well as to note any likely causes of divergence.

Time loss of dialysis session and reduction of blood flow to the filter (duration and quantity) were studied in all the patients of our unit (77 in February and 83 in June). The education level, the family environment, and the socioeconomic level of each patient were recorded together with the causes of time loss or quality of the given dialysis.

During February, 42/77 (54%) patients had a mean time loss of 25.8 ± 23.3 min/patient/month (5.16 min/patients/session), while in June 41/83 (49%) patients had a mean of 20.6 ± 22.1 min/ patient/month (3.82 min/patients/session) (p= not significant) (NS). This was mainly due to the nursing initiation of (35 cases in February and 37 in June), a difference that was not sig­nificant (p= NS).

The time loss due to nursing initiation in Feb­ruary was considerably bigger in comparison to the time loss in June 22.2 ± 14.1 min (ranging from 7-50) versus 13.8 ± 7 min respectively (range: 5-60 min), (p= 0.003). In February, less time was lost due to nursing causes during the first shift as compared to the second (n= 17, 15.2 ± 9.7 vs. n= 18, 28.1 ± 14.9, respectively, p= 0.004), while during June such a difference disappeared (n= 16, 12.8 ± 8.3 vs. n= 21, 14.6 ± 5.9, p= NS).

Time loss due to technical reasons was less in February in comparison to June (n=5, 18.4 ± 10.6 vs. n= 5, 36.6 ± 8.8, respectively, p= 0.018), most likely because the arteriovenous fistulae and catheters did not function satisfactorily in the second case.

The time loss because of the unadjusted dec­reased blood flow due to unadjusted blood pump was considerable in February (8 patients lost 20-150 mL/min of blood flow for 30-120 min), while it was less in extent in June, where only 3 patients lost 50-130 mL/min blood flow for 60-180 min, differences that were not sig­nificant (p= NS).

Time of dialysis session and regular blood flow to the filter (lost time and reduction of blood flow) were lost by those who were not educated, had a healthy family environment, and did not know the meaning of loss of dia­lysis time (new patients in hemodialysis) or were from low socioeconomic levels.

Segura et al studied 48 patients and noted that the loss of time, mainly owing to machine pre­paration, was roughly 10 min/dialysis session, and this loss was not made up proportionally by extending the duration of dialysis session. [6] Our results showed a reduction of 25.8 ± 23.3 min/ patient/month, whereas Palevsky et al observed a reduction of the programmed time of dialysis session of 5 min/patient/session, which was much lower in comparison to the finding of previous researchers. [7]

In our patients, the time loss was mainly owing to nursing initiation and was bigger in duration in comparison to all other causes of time loss (initiation of patients, problems of vascular access), while others noted that the time loss related to nursing initiation was mi­nimal (2% of time loss) in comparison to the time loss that resulted from the preparation of the machine (44% of time loss). [6] It is worth mentioning that the time loss owing to nursing initiation in our study concerned basically the behavior of two nurses, who systematically li­mited the duration of dialysis session of certain patients (old patients feeble to react, low­educated individuals or those with low educated relatives etc.) despite the fact, that repeated ins­tructions were provided to the nurses concer­ning the importance of providing the required dialysis as well as general guidelines related to the subject. The difference in time loss of the given dialysis in accordance with the month was not significant despite the fact that acce­leration of the processes of dialysis during the summer months is expected. This was because one of the two nurses who were noncompliant was on vacation for 15 days in June.

Education is of particular importance for com­pliance of patients as well as the individualized attention paid by the staff to them. The encou­ragement from the medical staff, the society, and the family [8] besides the race, the age, and other factors [2],[7] affect compliance of the patients. Furthermore, we noted that the time and the quality of training were of importance and these were related irreversibly with the loss of pro­grammed time of the dialysis session. It was observed, that when the length of the period of education was sufficient and of better quality, the time loss was small. [4]

We usually try to achieve highest blood flow to the filter, however, mechanical causes or even others that are related to the vascular access (fistulae) sometimes do not allow the achieve­ment of the desirable blood flow. Of course, this occurred in a small percentage of our patients, a fact that implies good vascular acce­ sses and dialysis machines.

The following can be concluded from the patients of our unit:

  1. there was a small time loss and quality of dialysis session,
  2. time loss was mainly due to nursing initiation, while the reduction of blood flow to the filter was mainly due to mechanical or technical problems, and
  3. time loss of dialysis session did not depend on the season, but on the shift (more in the second one) as well as the sensitivity of nurses.



   Acknowledgments Top


We greatly appreciate the support of Mrs. Polyxeni Mavromatidou for her secretarial assistance.

 
   References Top

1.Sherman RA, Cody RP, Matera JJ, Rogers ME, Solanchick JC. Deficiencies in delivered hemo­dialysis therapy due to missed and shortened treatments. Am J Kidney Dis 1994;24(6):921-3.  Back to cited text no. 1    
2.Leggat JE Jr, Orzol SM, Hulbert-Shearon TE, et al. Noncompliance in hemodialysis: Predictors and survival analysis. Am J Kidney Dis 1998; 32(1):139-45.  Back to cited text no. 2    
3.Bleyer AJ, Hylander B, Sudo H, et al. An international study of patient compliance with hemodialysis. JAMA 1999;281(13):1211-3.  Back to cited text no. 3    
4.Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int 2003;64(1):254-62.  Back to cited text no. 4    
5.Charra B, Laurent G, Chazot C, Jean G, Terrat JC, Vanel T. Hemodialysis trends in time, 1989 to 1998, independent of dose and outcome. Am J Kidney Dis 1998;32(6 Suppl 4):S63-70.  Back to cited text no. 5    
6.Segura L, Doleson MT, Pastre F, et al. Dialysis time: what you prescribe is what you get? (WYPIWYG). EDTNA ERCA J 1998;24(1):43­4.  Back to cited text no. 6    
7.Palevsky PM, Washington MS, Stevenson JA, et al. Barriers to the delivery of adequate hemodialysis in ESRD Network 4. Adv Ren Replace Ther 2000;7(4 Suppl 1):S11-20.  Back to cited text no. 7    
8.Kutner NG. Improving compliance in dialysis patients: Does anything work? Semin Dial 2001;14(5):324-7.  Back to cited text no. 8    

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Correspondence Address:
Konstantinos Mavromatidis
Renal Department, General Hospital of Komotini, Antoni Rossidi 11, 69100 - Komotini
Greece
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PMID: 19237822

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