WCN26-7988 SOCIO-CULTURAL BARRIERS AND LANGUAGE INEQUITIES IN THE SELF-CARE OF HEMODIALYSIS PATIENTS IN PARAGUAY

quality dialysis care.Anaemia remains one of the most prevalent and devastating complications of ESRD, contributing to poor quality of life and increased hospitalization rates.Local studies report anaemia prevalence ranging from 25-50% among haemodialysis patients, with only 30-40% receiving regular erythropoietin therapy and frequent blood transfusions still common in several units.This is just a glimpse of substantial gaps in access, monitoring, and protocol adherence.Although optimization of erythropoiesis-stimulating agents (ESA) and iron therapy is proven to improve outcomes, achieving target haemoglobin (Hb) levels remains challenging in such resource limited settings, underscoring the need for locally tailored Quality Improvement (QI) strategies.This project aimed to increase erythropoietin uptake, improve anaemia management, and reduce transfusion dependence among haemodialysis patients through a structured Quality Improvement Project (QIP) employing barrier identification and targeted interventions.Methods: A Quality Improvement (QI) project was conducted in the maintenance haemodialysis unit from October 2024 to April 2025 using the Plan-Do-Study-Act (PDSA) framework to improve anaemia management and increase erythropoietin (EPO) uptake.The study included all adult patients receiving maintenance haemodialysis twice or thrice weekly.Baseline demographic data, haemoglobin levels, iron indices, transfusions for Renal anaemia and EPO use were recorded.Erythropoietin (EPO) adherence was defined as consistent administration of prescribed doses over a 3-month period, administered after haemodialysis (HD) under direct observation.During the first PDSA cycle, barriers to optimal anaemia management were identified through patient interviews and staff discussions.The glaring and pre-dominant barrier was financial i.e cost of EPO as it was not being provided free of cost which limited access for many patients.Collaborative negotiations were initiated with pharmaceutical companies, leading to innovative cost-reduction strategies and direct delivery of medications to patients, ultimately achieving an approximate 60% reduction in EPO cost.Educational sessions for staff and patients and reinforcement of anaemia monitoring protocols were also implemented.EPO uptake and haemoglobin improvement were reassessed at three and six months to evaluate progress from the baseline.Results: A total of 114 maintenance haemodialysis patients who had been on dialysis for more than six months were included in the project.Of these, 34 (30%) were female and 80 (70%) were male, with approximately 70% having received dialysis for less than five years.Following the QI intervention, there was a marked improvement in anaemia management indicators.The rate of blood transfusions exclusively for renal anaemia decreased from 32 (previous three months) to 4 over the next three-month observation period, representing an 81% reduction.Erythropoietin (EPO) adherence increased from approximately 30% at baseline to 95% post-intervention, reflecting a 65% absolute improvement.Similarly, the proportion of patients achieving target haemoglobin levels (9-12 g/dL) rose from 37% to 77%, a 40-percentage-point increase.Conclusion: Collaborative cost reduction, structured education, and systematic follow-up led to significant improvements in EPO adherence, haemoglobin target achievement, and reduced transfusion dependence.Sustaining these improvements will require ongoing staff engagement and periodic re-audits to reinforce best practices and maintaining long-term quality outcomes.Long term goals involve advocacy to provide the EPO free of cost or shift to HIF stabilizers that can prove to be more cost effective in eligible patients.I have no potential conflict of interest to disclose.I used generative AI and AI-assisted technologies in the writing process.During the preparation of this work the authors used ChatGPT in order to improve readability and language.After using this service,