An assessment of the renal patient’s level of nutritional knowledge at the Hemodialysis Unit at the Cornwall Regional Hospital (CRH)

OBJECTIVE: Little is known about hemodialysis patients’ nutrition knowledge level concerning the management of their disease. The aim of the research was to determine the level of nutrition knowledge related to renal disease, nutritional status and usual dietary patterns of hemodialysis patient at Cornwall Regional Hospital (CRH). DESIGN AND METHODS: A twenty six (26) item structured questionnaire consisting of closed ended questions were used to record anthropometry, biochemical markers, usual dietary patterns. The sample size was 106 patients and data were collected quantitatively. Data were analysed using Microsoft Excel. RESULTS: One half (49%) of respondents had a misconception of high potassium foods, while 38.5 % had a lack of knowledge of high or low sodium food sources. The usual dietary intake revealed 46% ate foods from animals 2 times daily; 36% once daily and 16% 3 times daily. Only 34% of the participants were knowledgeable about the correct amount of Foods from Animals (FFA) that should be consumed daily according to their weight. Albumin level below 35g/L was found in 34% of the sample; while 12% of the sample population had a Body Mass Index below 18.5 kg/m2 (underweight); 70% had a high phosphorus level and 17% had a high potassium level. CONCLUSION: Nutrition knowledge level deficit was observed which affected the patients’ nutritional status. Multidisciplinary approaches including educational interventions are needed to improve patient care outcome.

Renal dialysis in Barbados - part 1: cost of dialysis provision at the Queen Elizabeth Hospital

OBJECTIVE: The purpose of this study was to assess the health service cost of haemodialysis delivered by the Queen Elizabeth Hospital, Barbados. DESIGN AND METHODS: A cost analysis was performed from the viewpoint of the study hospital using the treatment protocols based on current practice. These incorporated procedures to establish dialysis access sites (surgical set up) and dialysis maintenance. Cost and patient data were collected for the period April 1, 1998 to March 31, 1999. Sixty-four patients were studied. Analyzed costs included personnel, drug expenditure, supplies (dialysis and non-dialysis related), inpatient costs, laboratory and other ancillary services, and indirect or overhead costs such as plant, housekeeping, laundry and administration. RESULTS: The final cost per patient year was $37,930.04 in the first year of dialysis and included surgical set-up, and $34,059.08 in the subsequent years (excluding inpatient admissions and treatments for complications). The total cost of dialysis provision for the year excluding surgical set up was $2,178,561.09. The cost per visit was estimated to be $286.95. Direct costs (determined by patient utilization and physician and nurse directives) amounted to 81.8 percent of total cost. The main expenditure sections were dialysis-related supplies, labour and overheads. Cost savings incurred as a result of strict modification of treatment guidelines were estimated. By altering the number of dialysis visits per week and introducing other cost saving measures, such as dialyzer re-use, a savings of $852,176.32 was observed with a full potential savings of $902,218.63. An incremental cost analysis of a service expansion (scenario 1) indicated that the cost savings would be sufficient to provide an additional 3,328 dialysis treatments or visits per year, incorporating 4 additional dialysis machines. CONCLUSIONS: These findings are important in the light of constrained economic resources. However, the outcomes associated with the observed costs must be explored in order to assess the "true value" or cost effectiveness of the current dialysis practice. Therefore, this analysis is but one component of an overall study to review the renal dialysis services in Barbados for the purpose of informing plans for expansion and optimization of services.(Au)

Haemodialysis at University Hospital, Mona

Haemodialysis at University Hospital commenced in 1970. One hundred and twenty six patients have been accepted for regular dialysis. Hypertension and chronic glomerulonephritis accounted for 117 patients (93 percent) while 4 patients (3 percent) had polycystic kidneys and 5 patients (4 percent) had diabetes mellitus. Twenty-nine (23 percent) patients received a cadavericrenal transplant. There were eighty-five (68 percent) deaths. Twenty-five patients (30 percent) died in less than one year, twenty-two (25 percent) died between one and two years. Seventeen patients (20 percent) survived over five years before death, and three patients surviving over 10 years. There are twenty patients on regular hospital dialysis at present in the University Hospital, twelve patients have been on dialysis less than 3 years, three patients have been on 3-5 years, and five patients have been on for greater than 5 years and two patients greater than 10 years