Quantifying the advantages and acceptability of linking dialysis machines to an electronic medical record.

AIM: To establish and quantify the time saved by redirecting nursing workload from recording and entering haemodynamic data during chronic dialysis sessions by linking dialysis machines directly to the electronic medical record. METHODS: We developed a bespoke interface from the HL7 feed from the dialysis machines (largely Fresenius 5008) to our EMR system (Cerner). We quantified the time nurses spent with the patient, computer, dialysis machine and sorting our patient related issues by observation using independent observers in a time and motion study. We performed these observations before and after implementation of the computer interface. We established patient and nursing acceptance by survey. We established adequacy of observations by counting the number of patients who received the minimum number of observations recorded in the system before and after implementation. RESULTS: Implementation of a dialysis machine direct EMR interface reduced the time the nurses spent with the computer significantly by ∼9 % (around 28 min, p < 0.05) per dialysis shift, and this was accompanied by a similar increase in time spent sorting out patient-related issues. The interface was well accepted by staff and patients. An immediate benefit was a ∼60 % improvement in the adequacy of recording vital signs in our dialysis patients. Then simply by showing these results to the nursing staff there was further improvement. CONCLUSIONS: In these days of machine interconnectivity there is really no good reason why dialysis nurses should be used to transfer data between machines. It is far better to utilise their skills in helping patients with their medical issues. We have shown that such a link improves efficiency, patient and staff satisfaction and dialysis governance.

An analysis of antibody responses and clinical sequalae of the Sinopharm HB02 COVID19 vaccine in dialysis patients in the United Arab Emirates.

AIM: To establish the responses to the Sinopharm HB02 COVID-19 vaccination in the dialysis population, which are not well established. We examined the humoral responses to the Sinopharm COVID vaccine in haemodialysis patients. METHODS: Standard vaccinations (two doses at interval of ~21 days) were given to all consenting haemodialysis patients on dialysis (n = 1296). We measured the antibody responses at 14-21 days after the second vaccine to define the development of anti-spike antibodies >15 AU/ml after vaccination and observed the clinical effects of vaccination. RESULTS: Vaccination was very well tolerated with few side-effects. In those who consented to antibody measurements, (n = 446) baseline sampling showed 77 had positive antibodies, yet received full vaccination without any apparent adverse events. Positive anti-spike antibodies developed in 50% of the 270 baseline negative patients who had full sampling, compared with 78.1% in the general population. COVID infection continues to occur in both vaccinated and unvaccinated individuals, but in the whole group vaccination appears to have been associated with a reduction in the case fatality rate. CONCLUSION: The humoral immune responses to standard HB02 vaccination schedules are attenuated in a haemodialysis cohort, but likely the vaccine saves lives. We suggest that an enhanced HB02 vaccination course or antibody checking may be prudent to protect this vulnerable group of patients. We suggest a booster dose of this vaccine at 3 months should be given to all dialysis patients, on the grounds that it is well tolerated even in those with good antibody levels and there may be a survival advantage.

Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody.

BACKGROUND: Individuals with end-stage kidney disease (ESKD) on dialysis are vulnerable to contracting COVID-19 infection, with mortality as high as 31 % in this group. Population demographics in the UAE are dissimilar to many other countries and data on antibody responses to COVID-19 is also limited. The objective of this study was to describe the characteristics of patients who developed COVID-19, the impact of the screening strategy, and to assess the antibody response to a subset of dialysis patients. METHODS: We retrospectively examined the outcomes of COVID19 infection in all our haemodialysis patients, who were tested regularly for COVID 19, whether symptomatic or asymptomatic. In addition, IgG antibody serology was also performed to assess response to COVID-19 in a subset of patients. RESULTS: 152 (13 %) of 1180 dialysis patients developed COVID-19 during the study period from 1st of March to the 1st of July 2020. Of these 81 % were male, average age of 52​ years and 95 % were on in-centre haemodialysis. Family and community contact was most likely source of infection in most patients. Fever (49 %) and cough (48 %) were the most common presenting symptoms, when present. Comorbidities in infected individuals included hypertension (93 %), diabetes (49 %), ischaemic heart disease (30 %). The majority (68 %) developed mild disease, whilst 13 % required critical care. Combinations of drugs including hydroxychloroquine, favipiravir, lopinavir, ritonavir, camostat, tocilizumab and steroids were used based on local guidelines. The median time to viral clearance defined by two negative PCR tests was 15 days [IQR 6-25]. Overall mortality in our cohort was 9.2 %, but ICU mortality was 65 %. COVID-19 IgG antibody serology was performed in a subset (n = 87) but 26 % of PCR positive patients (n = 23) did not develop a significant antibody response. CONCLUSIONS: Our study reports a lower mortality in this patient group compared with many published series. Asymptomatic PCR positivity was present in 40 %. Rapid isolation of positive patients may have contributed to the relative lack of spread of COVID-19 within our dialysis units. The lack of antibody response in a few patients is concerning.