Conclusions: Patients with a sNa lower than the dNa did not show significant differences in IDWG, rates of intra-dialytic hypotension nor reduction in target UF volumes. Small patient numbers
and event rates may have obscured an actual association, and further investigation is warranted. 240 HOME BEFORE HOSPITAL”: A WHOLE SYSTEM APPROACH AT MAKING A CHANGE D CHIAPPETTA, K FALLON, RG WALKER Alfred Hospital, Melbourne, Victoria, Australia Aim: To improve the Alfred Health home therapy rates from 15% (2011) by at least 2.5% per year. Background: Alfred Health’s prevalent home therapies rate was suboptimal. In order to meet State target of 35% a shift from in centre to home based therapies needed to occur acknowledging limitations in the overall growth in dialysis patient numbers. Designing the model of care to establish home based therapies initially has better potential for success. Alfred Health embarked on a Ixazomib research buy GSI-IX in vitro 2 year redesigning care project embracing a whole system approach at making a change. Methods: Principles were developed to support all model of care changes: A consistent model of dialysis care across hub and spoke. Early referral and education. Prioritising Home Therapies as
initial choice. Home therapies default with an opt out option Patient choice; focus towards peritoneal dialysis (PD) Incorporate urgent care Providing high level support for home therapies, to patients, carers and staff. Achieving KPI’s for key stakeholders. Results: During this redesign process we achieved eltoprazine a defined renal pathway supporting the “home before hospital”
philosophy, a pilot ‘outreach’ service targeting early referral and patient education a pilot ‘hybrid’ – self care model to increase patient self care capacity. improved access to Tenckoff catheter insertion by interventional radiology team An increase from 15% to 22% prevalence rate for home therapy patients and increased incident rate to 55%5 occurred in the first year of the project. Conclusions: Final reporting is pending but the preliminary conclusion is that a whole system approach has been associated with rapidly increasing Alfred Health home therapy rates. 241 ACCURACY AND UTILITY OF ESTIMATING LEAN BODY MASS AND NUTRITIONAL STATUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON LONG-TERM HAEMODIALYSIS USING ANTHROPOMETRIC SKIN FOLD THICKNESS MEASUREMENTS K LEONG, A SKELLEY, J CHEE, K WONG Peninsula Health, Victoria, Australia Aim: To estimate the utility and accuracy of skin fold thickness measurements using simple callipers in estimating lean body mass in haemodialysis patients and comparing this with lean body mass measured by Dexa scan. Background: Malnutrition is common in dialysis patients with a prevalence of 30–50% and associated with higher mortality. Lean body mass (LBM) assessment is an accurate way of assessing nutritional status.