Implementing incremental haemodialysis

Key learning point

Incremental HD is a good quality of life option for certain patients and offers high value with reduced environmental and cost impact. 

Setting/Patient Group: Dialysis Unit

Issue to be addressed:

Those starting dialysis have residual urine output. If this is >600ml/day (and no other exclusion factors) an individualized ‘incremental’ dialysis prescription can be adopted for improved quality of life (QoL).

Intervention:

• Assessed existing evidence and safety data.
• Determined equations for integrating dialysis adequacy monitoring/reports into existing IT software, calculating a combined urinary and HD-associated clearance to provide a single measure of ‘adequacy’.
• Protocol and patient information sheet for incremental HD written, with involvement of patients.

Outcome:

Clinical

• Non-inferior QoL outcomes
• iHD patients had fewer in-patient days; median 32 (± 54) /1000 patient days, compared to an average ‘new start’ HD 51/1000 days
• Theoretical benefit for patients through maintenance of residual kidney function

Social

• Patient and staff time saved from reduced length of stay.

Environmental

• Estimated annual carbon savings of 0.8 tonnes CO2e per patient/yr  (from reducing residual concentrate volume and disposal)
• Additional reduction in water use, waste water, and air pollution.

Economic

• Estimated savings of between £4,800 and £8,000 per patient year on incremental HD