IMPACT OF PATIENT AND DIALYSIS THERAPIST EDUCATION ON DIALYSIS ADEQUACY AND ULTRAFILTRATION RATES IN THREE RURAL PUBLIC PRIVATE PARTNERSHIP MODEL CENTERS FROM SOUTH INDIA

Introduction:

Enhanced blood flow during dialysis is associated with improved dialysis adequacy as measured by Kt/V. A higher ultrafiltration rate (UFR) is associated with higher mortality. This study aims to evaluate the effects of continued patient education combined with dialysis therapist training  on blood flow, Kt/V, and ultrafiltration rates in dialysis patients over a one-year period across three dialysis centers in south India that cater predominantly to a rural populace.

Methods:

This retrospective study analyzed data from 289 patients across three dialysis centers over a 12-month period. The centers are run on a public private partnership (PPP) model where the government pays for the dialysis sessions and no charges are levied on the patients.  Average monthly data from multiple dialysis sessions were collected, focusing on changes in blood flow rates, Kt/V values, and ultrafiltration volumes. The interventions included continued patient education to minimize interdialytic weight gain through periodic counseling by dieticians. Dialysis therapists were continually trained by physicians to improve blood flows and achieve the minimum recommended Kt/V of 1.2 every session. The analysis also considered demographic factors such as age and gender to identify their associations with dialysis outcomes using Spearman rank correlation test.  Differences between the centers and potential trends over time were evaluated to understand the impact of the interventions.

Results:

77% of the patients were male. Mean age was 53+/-12.7 years. The interventions were associated with an increase in blood flow rates across all three centers, which in turn resulted in improvements in Kt/V. UFR also decreased over the period. Over 1 year, in the first center (Adoni), average blood flow increased from 243 to 259 mL/min, potentially due to the intervention. There was an increase in average Kt/V from 1.17 to 1.38 and a decrease in average ultrafiltration from 2634 mL to 2339 mL. The second center (Atmkur) reported an increase in average blood flow from 254 to 298 mL/min,  a rise in average Kt/V from 1.02 to 1.35 and a reduction in average ultrafiltration from 3438 mL to 2620 mL. In the third center (Nuziveedu), average blood flow increased from 221 to 244 mL/min, improvement in average Kt/V from 1.13 to 1.39 and a decrease in average ultrafiltration from 2732 mL to 2141 mL. On Spearman rank correlation  analysis revealed that the male gender was associated with significantly higher blood flow rates and ultrafiltration but lower Kt/V. An increase in age correlated with a significant decrease in achieved  Kt/V. No other significant differences in outcomes were observed across the centers. A limitation of the study is the reliance on average data, which may not reflect individual patient conditions. Other measures of adequacy like hemoglobin levels, phosphate control were not analyzed. 

Conclusions:

Continued patient and dialysis therapist education can lead to better patient outcomes in resource limited settings. This study underscores the importance of implementing comprehensive patient education programs in dialysis centers. Additionally, tailoring interventions based on demographic factors such as age and gender may further optimize patient outcomes. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.