Why are we so poor at delivering hemodialysis and what can we do about it? - PWR 10.27/2023

Improving Hemodialysis - BCR PWR (October 2023)
Dr. Chris McIntyre presents his talk, “Why are we so poor at delivering hemodialysis and what can we do about it?” as part of BC Renal’s province-wide rounds.
0:04:00 - Introduction
Dr. McIntyre starts by discussing how difficult hemodialysis (HD) can be for patients, noting it can be worse than some forms of cancer.
0:08:00 - The Effects of HD on the Body
He then highlights ways in which hemodialysis can negatively affect the body, including blood vessels, heart and brain. Notably, altered blood flow during HD can cause brain injury and cognitive decline (in terms of reasoning, memory, a verbal abilities). He highlights data from a study measuring blood flow in the brain after dialysis, which shows a dramatic decrease.
0:29:00 - Salt and Hemodialysis
Dr. McIntyre talks about human’s evolutionary ability to store salt in certain tissues, such as the skin. He notes that dialysis patients have particularly high levels of sodium in the skin and heart, which can be detrimental in the context of cardiovascular disease.
0:24:00 - Innovation
He points to various solutions to improve the delivery of dialysis, including how remote ischemic preconditioning (RIPC) can protect tissues from ischemic injury, and synthetic angiopoietin 1 mimetic as a drug intervention to protect the brain. Dr. McIntyre highlights results from the MY TEMP Trial in Ontario, where thousands of patients were randomly assigned to receive cooling during dialysis, and evidence showing how exercise can improve dialysis outcomes. He emphasizes that multiple solutions be adopted to improve the delivery of HD.
0:36:00 - Measuring impact
He highlights a novel PROM clinical tool developed by his team, which is available in app form. HD patients can use it on a daily basis to report their symptoms and quality of life.
0:39:00 - Complex problem, complex intervention
Dr. McIntyre provides a brief overview of the HemoLab Patient Optimization Program.
0:43:00 - Q&A from the Audience
Dr. McIntyre takes questions from the audience.
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