179 Using the IPOS-Renal symptom score to better understand the symptom burden of patients receiving in-hospital haemodialysis: a Quality Improvement Project

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Introduction Patients receiving haemodialysis often carry a high symptom burden, which negatively impacts their quality of life. Kidney teams often underestimate this burden, but recognition can be improved by use of validated symptoms scores, such as the IPOS-Renal. Recent international kidney guidelines (KDIGO) recommend regular and routine use of symptom scores, as well as open questioning, for all dialysis patients, but this practice is not yet widespread. Methods We piloted routine use of healthcare-assistant-led IPOS-Renal administration in our local hospital-based haemodialysis unit, looking to understand potential feasibility and benefit of this. Our SMART goal was >50% completion of IPOS-Renal symptom questionnaires within the Wonford haemodialysis unit population within 4 months of project start. Results 44 IPOS-Renal questionnaires were completed for 42 patients between December 2023 and April 2024. 26 (59%) were completed by patients alone, 11 (25%) with the help of a friend and 7 (16%) with help from staff. ~70% of patients currently dialysing in the Wonford HD unit had completed an IPOS-Renal in the past 3 months. The most common symptom identified was weakness (77%), followed by poor mobility (68%), and pain and itch (both 59%). High symptom scores were fed back to patients’ nurses and nephrologist, discussed at MDT meetings and led to changes in management and referrals for further support for several patients. Conclusions Routine collection of IPOS-Renal symptom questionnaires was a feasible and effective way to garner better understanding of the symptoms experienced by our haemodialysis population. This information can be fed back to dialysis nurses, nephrologists and the renal supportive care nurse to address symptoms and identify patients for whom haemodialysis is not providing benefit.

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