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Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease
Background: End Stage Renal Disease is an irreversible decline in kidney function and fatal in the absence of renal replacement therapy. Resource constraints in the South African public healthcare sector limits patients' access to renal replacement therapy: here 14.8% are on haemodialysis compared t...
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| Format: | Thesis |
| Language: | English |
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Department of Clinical Laboratory Sciences
2021
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| _version_ | 1867613216654229504 |
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| access_status_str | Open Access |
| author | van der Nest, Yolinda Louise |
| author2 | Kyriacos, Una |
| author_browse | Kyriacos, Una van der Nest, Yolinda Louise |
| author_facet | Kyriacos, Una van der Nest, Yolinda Louise |
| author_sort | van der Nest, Yolinda Louise |
| collection | Thesis |
| description | Background: End Stage Renal Disease is an irreversible decline in kidney function and fatal in the absence of renal replacement therapy. Resource constraints in the South African public healthcare sector limits patients' access to renal replacement therapy: here 14.8% are on haemodialysis compared to 85.2% in private dialysis units. Quality indicators in internationally accepted guidelines address complications of End Stage Renal Disease for patients on haemodialysis to reduce mortality and morbidity. Monitoring clinical outcomes for patients on haemodialysis is essential for good quality of life. Aim: To design and validate a record review template for monitoring and describing target and actual outcomes for each clinical indicator to assess adherence to established guidelines. Methods Design: Retrospective chart review. Participants: Patient records were accessed from an electronic database in 8 private units between 01 January and 31 December 2018. Data instruments: Data were captured and analysed in SPSS. DAG Stat was used for the Kappa statistic for interrater reliability (test-retest). A P-value of <0.05 was taken as significant. Results: Of the dialysis population (N=412) for the study period n=243 (58.98%) records were excluded. The median age of the convenience sample (169/412, 41.01%) was 60 years (IQR: 21-86), comprising 100/169 (59.17%) males and 69/169 (40.8%) classified as Coloured. Most patients (55/169, 32.54%) had Diabetic Nephropathy. Suboptimal dialysis adequacy (Kt/V levels) was present in 86/133 (64.6%) of the patients, similarly 102/166 (62.5%) for serum phosphate. Arterio-venous fistula or graft is recommended for vascular access for HD and 112/169 (66.27%) patients had either. While all patients should receive erythropoiesis stimulating agents and iron therapy, 110/169 (65.08%) and 104/169 (61.53%) respectively did. For the required phosphate binders and Vitamin D supplements there were recordings for 57/169 (33.72%) and 54/169 (32.72%) patients respectively. Conclusion: Adherence to clinical guidelines for 3/5 quality indicators was considered unsatisfactory which has implications for patients' quality of life. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/33959 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:37.404Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Department of Clinical Laboratory Sciences |
| publisherStr | Department of Clinical Laboratory Sciences |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/33959 Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease van der Nest, Yolinda Louise Kyriacos, Una Nursing Background: End Stage Renal Disease is an irreversible decline in kidney function and fatal in the absence of renal replacement therapy. Resource constraints in the South African public healthcare sector limits patients' access to renal replacement therapy: here 14.8% are on haemodialysis compared to 85.2% in private dialysis units. Quality indicators in internationally accepted guidelines address complications of End Stage Renal Disease for patients on haemodialysis to reduce mortality and morbidity. Monitoring clinical outcomes for patients on haemodialysis is essential for good quality of life. Aim: To design and validate a record review template for monitoring and describing target and actual outcomes for each clinical indicator to assess adherence to established guidelines. Methods Design: Retrospective chart review. Participants: Patient records were accessed from an electronic database in 8 private units between 01 January and 31 December 2018. Data instruments: Data were captured and analysed in SPSS. DAG Stat was used for the Kappa statistic for interrater reliability (test-retest). A P-value of <0.05 was taken as significant. Results: Of the dialysis population (N=412) for the study period n=243 (58.98%) records were excluded. The median age of the convenience sample (169/412, 41.01%) was 60 years (IQR: 21-86), comprising 100/169 (59.17%) males and 69/169 (40.8%) classified as Coloured. Most patients (55/169, 32.54%) had Diabetic Nephropathy. Suboptimal dialysis adequacy (Kt/V levels) was present in 86/133 (64.6%) of the patients, similarly 102/166 (62.5%) for serum phosphate. Arterio-venous fistula or graft is recommended for vascular access for HD and 112/169 (66.27%) patients had either. While all patients should receive erythropoiesis stimulating agents and iron therapy, 110/169 (65.08%) and 104/169 (61.53%) respectively did. For the required phosphate binders and Vitamin D supplements there were recordings for 57/169 (33.72%) and 54/169 (32.72%) patients respectively. Conclusion: Adherence to clinical guidelines for 3/5 quality indicators was considered unsatisfactory which has implications for patients' quality of life. 2021-09-16T11:05:34Z 2021-09-16T11:05:34Z 2021 2021-09-16T11:05:00Z Master Thesis Masters MSc http://hdl.handle.net/11427/33959 eng application/pdf Department of Clinical Laboratory Sciences Faculty of Health Sciences |
| spellingShingle | Nursing van der Nest, Yolinda Louise Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| thesis_degree_str | Master's |
| title | Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| title_full | Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| title_fullStr | Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| title_full_unstemmed | Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| title_short | Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| title_sort | record review of post haemodialysis blood results to assess adherence to guidelines for end stage renal disease |
| topic | Nursing |
| url | http://hdl.handle.net/11427/33959 |
| work_keys_str_mv | AT vandernestyolindalouise recordreviewofposthaemodialysisbloodresultstoassessadherencetoguidelinesforendstagerenaldisease |