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Nardelli L, Scalamogna A, Messa P, Gallieni M, Cacciola R, Tripodi F, Castellano G, Favi E. Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice? Medicina (B Aires) 2022; 58:medicina58020214. [PMID: 35208541 PMCID: PMC8875254 DOI: 10.3390/medicina58020214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 12/28/2022] Open
Abstract
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.
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Affiliation(s)
- Luca Nardelli
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Antonio Scalamogna
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Piergiorgio Messa
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy;
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Roberto Cacciola
- Department of Surgical Sciences, Università di Tor Vergata, 00133 Rome, Italy;
| | - Federica Tripodi
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Evaldo Favi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-3666036167
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102
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Yang Z, Luo Y, Lu H, Zou B, Wang H, Chen G, Wu Y, Huang Y. Validation of the functional assessment of anorexia/cachexia therapy instrument to assess quality of life in maintenance hemodialysis patients with cachexia. Semin Dial 2022; 35:330-336. [PMID: 35032061 DOI: 10.1111/sdi.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/05/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many patients on maintenance hemodialysis (MHD) eventually suffer from cachexia. The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) is a tool used to evaluate the quality of life of patients with cachexia related to various diseases, but its suitability for use in MHD patients has yet to be verified. This study aimed to explore the validation of the FAACT in MHD patients by conducting reliability and validity tests. METHODS Qualified MHD patients were selected to complete the FAACT and Kidney Disease Quality of Life Short Form 36 (KDQOL-36) questionnaires, and their demographic data and biochemical test results were collected from electronic medical records. Next, the Cronbach's alpha coefficient, paired sample t test and ICC were used to analyze the scale consistency. Additionally, the association between the KDQOL-36 and FAACT was analyzed using Bland-Altman plots and Pearson correlation analysis. Finally, the patients were divided into groups to evaluate discriminant validity. RESULTS A total of 299 patients were included in this study. The Cronbach's alpha coefficients of the FAACT and its anorexia-cachexia subscale (ACS) were 0.904 and 0.842, respectively, and their ICC exceeded 0.90. The correlation coefficients between the FAACT and its items ranged from 0.146 to 0.631, and the correlation coefficients between the FAACT and KDQOL-36 dimensions ranged from 0.446 to 0.617. The Bland-Altman plots between the FAACT and KDQOL-36 showed that only 3.3% of the points were outside the 95% limits of agreement. The effects of cachexia status (present or absent) on FAACT and ACS scores had effect sizes of 0.54 (P < 0.001) and 0.60 (P < 0.001), respectively. The FAACT and ACS also significantly discriminated between patients with and without inflammation (P < 0.001). CONCLUSIONS The FAACT and ACS have acceptable reliability and validity in MHD patients and are suitable for measuring the quality of life of MHD patients with cachexia.
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Affiliation(s)
- Zhen Yang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yixin Luo
- School of Nursing, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Haizhen Lu
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Baolin Zou
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han Wang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guowei Chen
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yiping Wu
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yanlin Huang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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103
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Skoumalova I, Madarasova Geckova A, Rosenberger J, Majernikova M, Kolarcik P, Klein D, de Winter AF, van Dijk JP, Reijneveld SA. Health Literacy and Change in Health-Related Quality of Life in Dialysed Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020620. [PMID: 35055440 PMCID: PMC8776225 DOI: 10.3390/ijerph19020620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 12/10/2022]
Abstract
Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53–1.84; moderate-HL patients: 0.97/0.55–1.73) or mental HRQoL (low-HL patients: 1.00/0.53–1.87; moderate-HL patients: 0.95/0.53–1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.
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Affiliation(s)
- Ivana Skoumalova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Correspondence: ; Tel.: +421-055-234-3390
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University, Univerzitní 22, 771 47 Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Olomouc University Social Health Institute, Palacky University, Univerzitní 22, 771 47 Olomouc, Czech Republic
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
- II. Internal Clinic, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
| | - Maria Majernikova
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Peter Kolarcik
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University, Univerzitní 22, 771 47 Olomouc, Czech Republic
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenná 5, 040 01 Kosice, Slovakia;
| | - Andrea F. de Winter
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia; (A.F.d.W.); (J.P.v.D.)
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Olomouc University Social Health Institute, Palacky University, Univerzitní 22, 771 47 Olomouc, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
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Eneanya ND, Tiako MJN, Novick TK, Norton JM, Cervantes L. Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease. Semin Nephrol 2022; 41:563-573. [PMID: 34973700 DOI: 10.1016/j.semnephrol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas, Austin Dell Medical School, Austin, TX
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Lilia Cervantes
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
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105
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Brito-Suárez JM, Medina-Hernández E, Medeiros M, Cantú-Quintanilla G, Morales-Buenrostro LE, Diaz-González de Ferris ME, Valdez-Ortiz R. A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E. Manual on health self-management and patient-reported outcomes among low-income young adult Mexicans on chronic dialysis: Feasibility study. J Pediatr Nurs 2022; 62:129-135. [PMID: 34801325 DOI: 10.1016/j.pedn.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We evaluated disease knowledge/self-management skills among low-income Mexican young adults maintained on dialysis and to test the effectiveness of the A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E (AYNIL) Manual - Spanish Version on patient-reported outcomes. This is a low literacy teaching tool designed with patients and educators' input. DESIGN AND METHODS A quasi-experimental study was conducted in 17 chronic dialysis patients at Mexico City's Hospital General de México, Dr. Eduardo Liceaga. Ages 18-30-year-old completed disease knowledge/self-management and quality of life measures before the intervention and 6 weeks later. RESULTS Significant increases were observed on disease knowledge/self-management scores in the STARx questionnaire from 47 (IQ: 40,51) to 50 (IQ: 48,54) p = 0.04. The UNC-TRxANSITION Index increased significantly from 4.8 (IQ: 3.9,5.7) to 7.7 (IQ: 7.5,8.2) p ≤0.001. Significant increases in scores were detected in the "Burden of kidney disease" (p = 0.008), "Effects of kidney disease" " (p = 0.03) and " Dialysis staff encouragement" (p = 0.027) based on the KDQoL survey. CONCLUSIONS In this vulnerable population, the Spanish version of the A.L.L. Y.O.U. N.E.E.D. I.S. L.O.V.E. - AYNIL Manual improved CKD/ESRD disease knowledge/self-management skills and HRQoL. This study highlighted the need for low-literacy educational tools to improve patient-reported outcomes. PRACTICE IMPLICATIONS Young adults with CKD/ESRD can benefit from patient-centered educational interventions to enhance their autonomy and the development of self-management behaviors that improve patient-reported outcomes and potential complications of the disease. Special attention is needed in low-income patients with low rates of adherence to treatments and poor self-management skills.
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Affiliation(s)
- Juliette Marie Brito-Suárez
- Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico; Unidad de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Elba Medina-Hernández
- Servicio de Nefrología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Mara Medeiros
- Unidad de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | | | - Luis Eduardo Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Rafael Valdez-Ortiz
- Servicio de Nefrología, Hospital General de México, Dr. Eduardo Liceaga, Mexico City, Mexico.
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106
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Hussain J, Chawla G, Rafiqzad H, Huang S, Bartlett SJ, Li M, Howell D, Peipert JD, Novak M, Mucsi I. Validation of the PROMIS sleep disturbance item bank computer adaptive test (CAT) in patients on renal replacement therapy. Sleep Med 2022; 90:36-43. [DOI: 10.1016/j.sleep.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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107
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Tsarpali V, Midtvedt K, Lønning K, Bernklev T, Lippe NVD, Reisæter AV, Brunborg C, Heldal K. Health-Related Quality of Life in Older Kidney Transplant Recipients: A National Cohort Study of Short- and Longer-Term Outcomes. Kidney Med 2021; 3:974-983.e1. [PMID: 34939006 PMCID: PMC8664696 DOI: 10.1016/j.xkme.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Rationale & Objective Assessing the optimal therapy for older patients (aged ≥65 years) with end-stage kidney disease requires knowledge of longevity and health-related quality of life (HRQoL) outcomes. Kidney transplantation prolongs survival but its long-term impact on HRQoL in older recipients is not well defined. We aimed to prospectively evaluate HRQoL changes from enlisting until 3 years posttransplantation and examine pretransplantation predictors of posttransplantation outcomes. Study Design Prospective cohort study. Setting & Participants Patients 65 years and older enlisted at the Norwegian National Transplant Center between January 2013 and November 2016. Predictors Kidney transplantation, dialysis vintage, and pretransplantation comorbidity assessed using the Liu Comorbidity Index. Outcomes HRQoL, assessed using the Kidney Disease Quality of Life Short Form, version 1.3. Analytical Approach HRQoL scores obtained at 3 years posttransplantation were compared with those obtained pretransplantation and after 1 year using a paired-sample t test. Multivariable linear mixed-effect models were used to identify possible predictors of HRQoL changes over time. Results Among 289 patients included, 220 (mean age, 71.5 years) had undergone transplantation and 136 had completed the 3-year HRQoL follow-up by October 2020. Posttransplant HRQoL, both generic and kidney specific, substantially improved and the benefit persisted for 3 years. For wait-listed candidates remaining on dialysis, HRQoL gradually deteriorated, and recipients who died within 3 years posttransplantation experienced no improvement during the first year. Moderately elevated pretransplantation comorbidity scores and prolonged dialysis vintage independently predicted poor HRQoL outcomes posttransplantation. Recipients receiving dialysis for 1 year or longer with pretransplantation comorbidity scores ≥ 7 experienced a marked and sustained physical deterioration after transplantation. Limitations Homogenous and highly selected population. Conclusions Transplantation is associated with a sustained HRQoL improvement and should be the preferred treatment for selected older patients. The value of a pretransplant comorbidity score to predict posttransplantation outcomes warrants further evaluation and may improve the selection process.
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Affiliation(s)
- Vasiliki Tsarpali
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Lønning
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Tomm Bernklev
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Oslo University Hospital, Oslo, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Kristian Heldal
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
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Equity or Equality? Which Approach Brings More Satisfaction in a Kidney-Exchange Chain? J Pers Med 2021; 11:jpm11121383. [PMID: 34945855 PMCID: PMC8709455 DOI: 10.3390/jpm11121383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.
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109
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Zhang F, Liao J, Zhang W, Wang H, Huang L, Shen Q, Zhang H. Effects of Baduanjin Exercise on Physical Function and Health-Related Quality of Life in Peritoneal Dialysis Patients: A Randomized Trial. Front Med (Lausanne) 2021; 8:789521. [PMID: 34912835 PMCID: PMC8666622 DOI: 10.3389/fmed.2021.789521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Exercise is an efficient non-pharmacological intervention for chronic kidney disease. The study aims to evaluate the effects of Baduanjin exercise on physical function and health-related quality of life (HRQOL) in peritoneal dialysis (PD) patients. Methods: Seventy PD patients were randomly assigned to either the Baduanjin exercise group or the control group. Fifty-seven patients completed the study (exercise group, 25; control group, 32). The exercise group received the Baduanjin exercise program for 12 weeks. The control group received usual care. Three well-established performance-based tests determined physical function: five times sit-to-stand test (FTSST), timed up and go test (TUGT), and handgrip strength (HGS). HRQOL was assessed by the Kidney Disease Quality of Life-Short Form. Results: At baseline, no differences in physical function and HRQOL were observed between the Baduanjin exercise and the control group. At follow-up, the Baduanjin exercise group showed a marginally significant improvement in FTSST (P = 0.008) and TUGT (P = 0.040) over the 12 weeks compared to the control group. HRQOL in the Baduanjin exercise group was significantly higher than that of the control group. Conclusions: A 12-week Baduanjin exercise program may improve physical function and HRQOL in PD patients. Longer follow-up is needed to determine if these findings will translate into clinical application.
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Affiliation(s)
- Fan Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Liao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weihong Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiyun Shen
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting. Int Urol Nephrol 2021; 54:1947-1955. [PMID: 34860339 PMCID: PMC9262769 DOI: 10.1007/s11255-021-03077-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. METHODS A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. RESULTS The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. CONCLUSION Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.
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Manenti L, Leuci E. Do you feel itchy? A guide towards diagnosis and measurement of chronic kidney disease-associated pruritus in dialysis patients. Clin Kidney J 2021; 14:i8-i15. [PMID: 34987778 PMCID: PMC8702818 DOI: 10.1093/ckj/sfab143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/30/2021] [Indexed: 01/14/2023] Open
Abstract
Chronic kidney disease-associated pruritus (CKD-aP) is a potentially distressing condition that affects a significant proportion of patients with end-stage kidney disease undergoing dialysis. CKD-aP may lead to worsening of patients' physical and mental health-related quality of life (HRQoL) and has also been linked with worse clinical outcomes, including increased mortality. Despite these detrimental effects, evidence from real-world studies shows that CKD-aP still remains overlooked by nephrologists and underreported by patients in clinical practice. Itch is subjective and therefore its diagnosis is often dependent on patients reporting this symptom. There is an opportunity to reduce the burden of CKD-aP on dialysis patients by increasing awareness about this condition and the availability of effective treatments. It is particularly important that nephrologists and other healthcare providers routinely ask their patients if they are experiencing itch. The differential diagnosis of CKD-aP requires a step-by-step identification and exclusion of possible alternative or concomitant causes of itch. Several simple validated self-reported assessment scales are available to evaluate the presence and severity of itch in a time-efficient manner, making them suitable for use in everyday clinical practice. The impact of CKD-aP on haemodialysis patients' HRQoL should also be assessed on a regular basis. This review provides a comprehensive overview of the differential diagnosis of CKD-aP and the diagnostic tools that are available to identify itch and quantify its severity and impact on patient HRQoL. A suggested algorithm to guide the screening, diagnosis and assessment of CKD-aP among dialysis patients in real-world practice is provided.
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Affiliation(s)
- Lucio Manenti
- Nephrology Unit, Parma University Hospital, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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Evaluating the feasibility and effectiveness of a mindfulness-based intervention on stress and anxiety of family caregivers managing peritoneal dialysis. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211054913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Mindfulness-based intervention (MBI) has not been evaluated for its feasibility and effectiveness in reducing stress and anxiety among family caregivers of patients on peritoneal dialysis (PD). Objectives (1) To evaluate the feasibility to include MBI during PD training for family caregivers. (2) To determine the effect of MBI on the caregivers’ levels of stress (perceived stress scale, PSS), anxiety state-trait anxiety inventory, STAI), QOL (short-form 36) and reactions to caregiving (caregiver reaction assessment, CRA). (3) To determine differences in the health-related QOL (Kidney Disease Quality of Life Instrument-Short Form, KDQOL PCS and SF-36 MCS) of care recipients with caregivers receiving MBI at 1 month, 3 months and 6 months when compared to those with caregivers receiving routine training. (4) To gather the caregiver’s feedback on the MBI. Methods This feasibility study recruited family caregivers to receive either mindfulness training (MT) or treatment-as-usual (TAU) group. Both groups received 4.5-days of structured PD training, but only caregivers in the MT group received 4 days of MT sessions, audio-guided mindfulness practice at home and weekly telephone follow-up. Results Forty-four family caregivers participated in this study. Including MBI as part of the PD training was feasible. There was a trend towards lower scores for PSS and T-STAI in the MT group compared to the TAU group. The baseline score of both PSS and T-STAI were positively correlated with post-intervention outcome scores. Conclusions Mindfulness-based intervention has the potential to improve psychological symptoms among caregivers of patients with PD.
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Skoumalova I, Madarasova Geckova A, Rosenberger J, Majernikova M, Kolarcik P, Klein D, de Winter AF, van Dijk JP, Reijneveld SA. Health-Related Quality of Life Profiles in Dialyzed Patients With Varying Health Literacy. A Cross-Sectional Study on Slovak Haemodialyzed Population. Int J Public Health 2021; 66:585801. [PMID: 34744558 PMCID: PMC8565259 DOI: 10.3389/ijph.2021.585801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: Chronic kidney disease (CKD) strongly affects patients’ health-related quality of life (HRQoL), mostly in the advanced stages of CKD. Health literacy (HL) may affect this association, in particular for some aspects of HRQoL. The aim of this study is to compare the profiles of HRQoL in dialyzed patients with varying HL. Methods: We obtained data on HL using the Health Literacy Questionnaire (HLQ) and on HRQoL using the Kidney Disease Quality of Life – Short Form (KDQoL-SF 1.3) in a multicentre cross-sectional study in 20 dialysis clinics in Slovakia (n = 542; mean age = 63.6 years; males: 60.7%). We compared HRQoL for three HL groups using ANOVA and the Kruskal-Wallis test. Results: Patients with low HL reported worse HRQoL than patients with moderate and high HL. The greatest differences between HL groups were found in the scales Effect of kidney disease, Cognitive function, Quality of social interaction, Social support, Dialysis staff encouragement, Patient satisfaction, Physical functioning, Pain, Emotional well-being and Social function. p-values in all cases were <0.001. Conclusion: Patients with low HL have a worse HRQoL in several domains than patients with a higher HL. Increasing HL capacities and better supporting patients with low HL should thus be given priority to support their HRQoL and at least maintain its level.
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Affiliation(s)
- Ivana Skoumalova
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic.,FMC-Dialysis Services Slovakia, Kosice, Slovakia
| | | | - Peter Kolarcik
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.,Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia.,Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea F de Winter
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands
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Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status. Qual Life Res 2021; 31:1441-1459. [PMID: 34748139 DOI: 10.1007/s11136-021-03018-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients. METHOD Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model. RESULTS MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024). CONCLUSION Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m2, better dietary phosphorus control, greater muscle strength and higher visceral protein pool.
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Kowalewski KF, Sidoti Abate MA, Neuberger M, Kirchner M, Krisam R, Egen L, Haney CM, Siegel F, Michel MS, Honeck P, Nuhn P, Westhoff N, Kriegmair MC. ROBOCOP II (ROBOtic assisted versus conventional open partial nephrectomy) randomised, controlled feasibility trial: clinical trial protocol. BMJ Open 2021; 11:e052087. [PMID: 34732486 PMCID: PMC8572388 DOI: 10.1136/bmjopen-2021-052087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Randomised controlled trials comparing robotic-assisted partial nephrectomy (RAPN) and open PN (OPN) are lacking. Therefore, we aim to report the study protocol and a trial update for a randomised controlled feasibility trial comparing RAPN versus OPN for renal neoplasms. METHODS AND ANALYSIS The ROBOtic assisted versus conventional Open Partial nephrectomy II trial is designed as a single-centre, randomised, open-label, feasibility trial. Participation will be offered to patients with renal neoplasms and deemed feasible for both, OPN and RAPN. We aim to enrol 50 patients within 15 months using a 1:1 allocation ratio. The primary endpoint of the trial is feasibility of recruitment and will be successful if one third of eligible patients agree to participate. Secondary endpoints include perioperative results, health-related quality of life, inflammatory response as well as surgical ergonomics of the operating team. If the primary outcome, feasibility of recruitment, is successful, the secondary results of the trial will be used for planning a confirmative phase III trial. ETHICS AND DISSEMINATION Ethical approval was obtained from the local institutional review board (Ethik-Kommission II at Heidelberg University: 2020-542N). Results will be made publicly available in peer-reviewed scientific journals and presented at appropriate congresses and social media. TRIAL REGISTRATION NUMBER NCT04534998.
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Affiliation(s)
| | | | - Manuel Neuberger
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Luisa Egen
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | | | - Fabian Siegel
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Maurice-Stephan Michel
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urological Surgery, University Medical Centre Mannheim, Mannheim, Germany
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Hu H, Liu X, Chau PH, Choi EPH. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res 2021; 31:1915-1932. [PMID: 34731388 DOI: 10.1007/s11136-021-03025-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To summarize the current evidence regarding the effectiveness of intradialytic exercise (IDE) on the health-related quality of life (HRQOL) of patients undergoing maintenance haemodialysis. METHODS Five English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and ScienceDirect) and four Chinese databases (VIP, WAN FANG, CNKI, CBM) were comprehensively searched from their inception to 18 March 2021. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected the papers and extracted the details of each study therein. Only randomized controlled trials were included. The risk of bias tool version 2.0 was used to evaluate the risk of bias of the included studies. A random-effects meta-analysis was conducted to pool the effect size. RESULTS Thirty-three eligible studies with 1481 participants were included. For the generic HRQOL, assessed by the Medical Outcomes Study Short-Form survey, IDE significantly improved most domains and the physical component summary compared with the control group. Furthermore, aerobic exercise alone significantly improved more domains compared to resistance exercise, combined aerobic and resistance exercise, and other types of exercise. Regarding the kidney-specific HRQOL, IDE improved three of eleven domains, including the symptom/problem list, the effect of kidney disease, and the quality of social interaction. No significant effect was found on other domains of kidney-specific HRQOL. CONCLUSION Intradialytic exercise could benefit patients undergoing haemodialysis in improving most domains of generic HRQOL, but the effect on most domains of kidney-specific HRQOL is insufficient.
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Affiliation(s)
- Huagang Hu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.,School of Nursing, Medical College, Soochow University, Box 203, 1 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xu Liu
- Department of Infectious Disease; Guangdong Provincial Engineering Research Center of Molecular Imaging; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Rd, Xiangzhou District, Zhuhai, 519000, Guangdong Province, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
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Lightfoot CJ, Howell M, Smith AC. How to assess quality of life in persons with chronic kidney disease. Curr Opin Nephrol Hypertens 2021; 30:547-554. [PMID: 34433189 DOI: 10.1097/mnh.0000000000000740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) significantly impacts many aspects of life, health, and wellbeing. People with CKD have individual priorities for their care which may differ from those valued by clinicians and policy makers. The patient experience is broadly captured by the concept of quality of life (QoL) which is increasing assessed in research and used to guide clinical and policy decision making. Appropriate selection and application of QoL assessment tools are essential for high-quality research and patient care. This article summarises the current approaches to QoL assessment in CKD and outlines aspirations for future improvement. RECENT FINDINGS Commonly used tools for assessment of QoL in CKD include the Short Form-36 and -12 and extended versions adapted for specific use in kidney patients (KD-QoL), and the EQ-5D. However, a wide range of other instruments are also reported, making comparisons between research findings challenging. Few of the tools are adequately validated for use in CKD, and relevance to patient values are unclear. Instruments suitable for use in a routine clinical setting are lacking. SUMMARY QoL instruments developed and validated with meaningful CKD stakeholder input are required. The Standardised Outcomes in Nephrology initiative is working to address this need.
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Affiliation(s)
- Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester
- Leicester NIHR Biomedical Research Centre, Leicester, UK
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Lee J, Abdel-Kader K, Yabes JG, Cai M, Chang HH, Jhamb M. Association of Self-Rated Health With Functional Limitations in Patients With CKD. Kidney Med 2021; 3:745-752.e1. [PMID: 34693255 PMCID: PMC8515078 DOI: 10.1016/j.xkme.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rationale & Objective In patients with chronic kidney disease (CKD), self-rated health ("In general, how do you rate your health?") is associated with mortality. The association of self-rated health with functional status is unknown. We evaluated the association of limitations in activities of daily living (ADLs) with self-rated health and clinical correlates in a cohort of patients with CKD stages 1-5. Study Design Prospective cohort study. Setting & Participants Patients with CKD at a nephrology outpatient clinic in western Pennsylvania. Outcome Patients participated in a survey assessing their self-rated health (5-point Likert scale) and physical (ambulation, dressing, shopping) and cognitive (executive and memory) ADLs. Adjusted analysis was performed using logistic regression models. Analytical Approach Logistic regression was conducted to examine the adjusted association of 3 dependent variables (sum of total, physical, and cognitive ADL limitations) with self-rated health (independent variable of interest). Results The survey was completed by 1,268 participants (mean age, 60 years; 49% females, and 74% CKD stages 3-5), of which 41% reported poor-to-fair health. Overall, 35.9% had at least 1 physical ADL limitation, 22.1% had at least 1 cognitive ADL limitation, and 12.5% had at least 3 ADL limitations. Ambulation was the most frequently reported limitation and was more common in patients reporting poor-to-fair self-rated health compared with those with good-to-excellent self-rated health (58.1% vs 17.4%, P < 0.001). In our fully adjusted model, poor-to-fair self-rated health was strongly associated with limitations in at least 3 ADLs (total ADL) [OR 8.29 (95% CI, 5.23-13.12)]. There was no significant association of eGFR with ADL limitations. Limitations Selection bias due to optional survey completion, residual confounding, and use of abbreviated (as opposed to full) ADL questionnaires. Conclusions Poor-to-fair self-rated health is strongly associated with physical ADL limitations in patients with CKD. Future studies should evaluate whether self-rated health questions may be useful for identifying patients who can benefit from additional evaluation and treatment of functional limitations to improve patient-centered outcomes.
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Affiliation(s)
- Jacqueline Lee
- Department of Medicine, School of Medicine, Pittsburgh, PA
| | - Khaled Abdel-Kader
- Vanderbilt University, Nephrology and Hypertension Division, Nashville, TN
| | - Jonathan G Yabes
- Center for Research on Health Care, Division of General Internal Medicine, Pittsburgh, PA
| | - Manqi Cai
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Hsin-Hsiung Chang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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Grove BE, Schougaard LMV, Ivarsen PR, Kyte D, Hjollund NH, de Thurah A. Patient-reported outcome measures for clinical decision-making in outpatient follow-up: validity and reliability of a renal disease questionnaire. J Patient Rep Outcomes 2021; 5:107. [PMID: 34655365 PMCID: PMC8520563 DOI: 10.1186/s41687-021-00384-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures are increasingly used by clinicians to support communication in telephone- or face-to-face consultations with patients. A renal disease questionnaire has been developed, but not sufficiently evaluated through clinimetrics in clinical setting. Hence, we aimed to evaluate the content validity, construct validity and the test-retest reliability of a renal disease questionnaire to be used for clinical decision-making. METHODS A content, construct validity and test-retest reliability study was conducted in 3 nephrology outpatient clinics in Central Denmark Region, Denmark. Content validity (face validity, comprehensibility and relevance) was assessed among 8 patients and 6 clinicians. Reliability was assessed by asking outpatients with chronic kidney disease to complete the questionnaire twice. Reliability was assessed by kappa statistics and agreement by percentage. Construct validity was determined using 4 a priori defined hypotheses and comparing 2 known groups. RESULTS Five new domains emerged, 6 items were rephrased and 3 items were removed following the content validity test. A total of 160 patients completed the questionnaire with median 8 days (IQR 2 days) between assessments. The test-retest reliability parameters of the single items in the questionnaire were substantial to almost perfect as all the observed weighted kappa values ranged from 0.61 to 0.91, 95% CI (0.34 to 0.95). In total, 61% of the single items showed almost perfect agreement. In total, 3 of the 4 hypotheses were accepted and 44% of the items showed satisfying known-group discriminative validity. CONCLUSION A renal disease questionnaire used for clinical decision-making in outpatient follow-up showed acceptable content validity and substantial to almost perfect reliability. Sufficient construct validity was not established. Incorporating the questionnaire into routine clinical practice may improve the evaluation of disease burden in patients with chronic kidney disease. We ask patients with chronic kidney disease (CKD) in Central Region Denmark to complete a questionnaire before each outpatient visit. The answers they provide are used to support communication with their health care provider. A questionnaire requires testing to ensure it can accurately capture important information about patient's symptoms and quality of life. When questionnaires are used to support communication between patients and health care professionals, they need to have good measurement properties. This means they need to be: (1) trustworthy, (2) relevant to a patient's health condition, (3) consistent and produce stable results every time. We explored the measurement properties of a questionnaire designed to be used in the face-to face outpatient visits for patients with CKD. We found that the questionnaire captured consistent and stable results. Using this questionnaire may help health care professionals to assess the patients´ burden of symptoms with a more patient-centered approach. Potentially, the use of the questionnaire will increase the patients´ ability to cope with their symptoms and strengthen patients´ involvement in the clinical decisions concerning their treatment.
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Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex, Center for Patient-Reported Outcomes, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Per Ramløv Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Derek Kyte
- School of Allied Health and Community, University of Worcester, Worcester, UK
- Aarhus University, Aarhus, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
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Hasan LM, Shaheen DAH, El Kannishy GAH, Sayed-Ahmed NAH, Abd El Wahab AM. Is health-related quality of life associated with adequacy of hemodialysis in chronic kidney disease patients? BMC Nephrol 2021; 22:334. [PMID: 34620098 PMCID: PMC8499489 DOI: 10.1186/s12882-021-02539-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Monitoring Health Related Quality of Life (HRQoL) in different stages of chronic kidney disease is advised by all nephrology societies. We aimed to study the relation between quality of life and dialysis adequacy. METHODS One hundred patients (51% males), on regular hemodialysis 3/week for > 6 months in two hospitals were included. Single pool Kt/V was used to assess dialysis adequacy. Patients were grouped into 3 divisions according to Kt/v: Group A > 1.5 (n = 24), group B 1.2-1.5 (n = 54) and group C < 1.2 (n = 22). KDQOL-SF™ questionnaire was used to study quality of life in our groups. Group C was reassessed after 3 months of improving Kt/v. RESULTS Mean values were: Kt/V (1.48 ± 0.41), Cognitive Function (84.27 ± 9.96), Work status (30.00 ± 33.33), Energy (45.70 ± 13.89), Physical Function and Role limitations due to physical function (45.30 ± 12.39 and 31.25 ± 19.26, respectively). Group A had significantly higher scores of KDQOL-SF except Role limitations due to Physical Function. All subscales improved in group C after Kt/v improvement except 3 subscales, namely, work status, patient satisfaction and role limitation due to physical and emotional functions. CONCLUSION Inadequate HD badly affects quality of life and improving adequacy refines many components of quality of life.
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Affiliation(s)
- Lamia M Hasan
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Mansoura, Egypt
| | - Dina A H Shaheen
- Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University Hospital, Mansoura, Egypt
| | - Ghada A H El Kannishy
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Mansoura, Egypt
| | - Nagy A H Sayed-Ahmed
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Mansoura, Egypt
| | - Ahmed M Abd El Wahab
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Mansoura, Egypt.
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Ryu JH, Koo TY, Ro H, Cho JH, Kim MG, Huh KH, Park JB, Lee S, Han S, Kim J, Oh KH, Yang J. Better health-related quality of life in kidney transplant patients compared to chronic kidney disease patients with similar renal function. PLoS One 2021; 16:e0257981. [PMID: 34606505 PMCID: PMC8489710 DOI: 10.1371/journal.pone.0257981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Renal functional deterioration is associated with physical and mental burdens for kidney transplant (KT) and chronic kidney disease (CKD) patients. However, the change in health-related quality of life (HRQOL) over time in KT patients compared to that of native CKD patients has not been evaluated. We addressed this issue using KT patients registered in the KNOW-KT cohort study and patients at CKD stage 1–3 registered in the KNOW-CKD cohort study. HRQOL scores were assessed using the Kidney Disease Quality of Life Short Form at baseline, 2-, and 4-years follow-up in 842 KT patients and at baseline and 5-year follow-up in 1,355 CKD patients. SF-36 scores declined at the 4-year follow-up, whereas CKD-targeted scores showed no change in the KT group. In contrast, CKD-targeted scores as well as SF-36 scores were decreased at the 5-year follow-up in CKD patients. When prognostic factors were analyzed for longitudinal HRQOL data over time, renal functions, diabetes, cardiovascular and cerebrovascular diseases, hemoglobin level, marital status, income, employment, and health care were significant prognostic factors. Furthermore, KT was an independent prognostic factor for better HRQOL. These results highlight that KT can offer a better HRQOL than that of CKD patients, even when renal function is similar.
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Affiliation(s)
- Jung-Hwa Ryu
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
- Nephrology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Tai Yeon Koo
- Nephrology, Seongnam Citizens Medical Center, Seongnam, Republic of Korea
| | - Han Ro
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Seoul Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: ,
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Murea M, Grey CR, Lok CE. Shared decision-making in hemodialysis vascular access practice. Kidney Int 2021; 100:799-808. [PMID: 34246655 PMCID: PMC8463450 DOI: 10.1016/j.kint.2021.05.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
Shared decision-making (SDM) is a process of collaborative deliberation in the dyadic patient-physician interaction whereby physicians inform the patients about the pros and cons of all available treatment options and reach an agreement with the patients on their preferred treatment plan. In hemodialysis vascular access practice, SDM advocates a deliberative approach based on the existence of reasonable alternatives-that is, arteriovenous fistula, arteriovenous graft, and central venous catheter-so that patients are able to form and share preferences about access options. In spite of its ethical imperative, SDM is not broadly applied in hemodialysis vascular access planning. Physicians and surgeons commonly deliver prescriptive fistula-centered recommendations concerning the approach to vascular access care. This paternalistic approach has been shaped by directions from long-held clinical practice guidelines and is reinforced by financial payment models linked with the prevalence of arteriovenous fistula in patients on hemodialysis. Awareness is growing that what may have initially seemed a medically and surgically appropriate approach might not always be focused on each individual's goals of care. Clinician's recommendations for vascular access often do not sufficiently consider the uncertainty surrounding the potential benefits of the decision or the cumulative impact of the decision on patient's quality of life. In the evolving health care landscape, it is time for the practice of hemodialysis vascular access to shift from a hierarchical doctor-patient approach to patient-centered care. In this article we review the current state of vascular access practice, present arguments why SDM is necessary in vascular access planning, review barriers and potential solutions to SDM implementation, and discuss future research contingent on an effective system of physician-patient participative decision-making in hemodialysis vascular access practice.
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Affiliation(s)
- Mariana Murea
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Carl R Grey
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Charmaine E Lok
- Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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A Protocol of Intradialytic Exercise for Improvements in Inflammatory Status, Body Composition, and Functional Capacity. Methods Mol Biol 2021. [PMID: 34473319 DOI: 10.1007/978-1-0716-1558-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Skeletal muscle wasting has been well-documented among hemodialysis patients. This catabolic condition can be induced by numerous factors, including low-grade inflammation, and is associated with impairments in functional capacity and quality of life, as well as an increased mortality risk. We previously showed that 12 weeks of intradialytic resistance training increases lean mass, functional capacity, and the quality of life of hemodialysis patients. This chapter provides the details of a protocol of intradialytic exercise that leads to improvements in inflammatory status, body composition, and functional capacity.
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Slaven A, Hsu J, Schelling JR, Navaneethan SD, Rincon-Choles H, McAdams-DeMarco MA, Schachere M, O’Malley N, Deluca J, Lustigova E, Wang X, Kusek J, Porter AC, Lash JP, Rahman M, Horwitz E. Social Support in Older Adults With CKD: A Report From the CRIC (Chronic Renal Insufficiency Cohort) Study. Kidney Med 2021; 3:776-784.e1. [PMID: 34693258 PMCID: PMC8515062 DOI: 10.1016/j.xkme.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE & OBJECTIVE Social support in older adults with chronic kidney disease (CKD) is a potentially modifiable factor that may affect important clinical outcomes such as health-related quality of life, cognitive function, and frailty. However, limited data about the effects of social support in older patients with non-dialysis-dependent CKD exist. Our objective was to evaluate the association of social support with health-related quality of life, cognitive function, and frailty in older adults with CKD. STUDY DESIGN Cross-sectional analysis of a prospective cohort study. SETTING & POPULATION 1,851 participants older than 65 years with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Social support (Lubben Social Network Scale [LSNS]). OUTCOMESS Health-related quality of life (Kidney Disease Quality of Life-36), cognitive function (Modified Mini-Mental State Examination, Trail Making Test A & B, and Buschke Selective Reminder Tests), and frailty (modified Fried frailty criteria). ANALYTIC APPROACH Multivariable, linear, and logistic regression to determine the association between social support and health-related quality of life, cognitive function, and frailty. RESULTS Low social support, defined as LSNS score < 12, was present in 22% of participants. On multivariable analysis, higher social support was associated with higher health-related quality of life (β coefficient per 1-SD increase in LSNS score; burden subscale, 2.57 (95% CI, 1.57-3.56); effects subscale, 2.21 (95% CI, 1.52-2.9); symptoms subscale, 1.64 (95% CI, 0.88-2.41); mental health composite subscale, 1.91 (95% CI, 1.40-2.43); and physical health composite score, 0.64 (95% CI, 0.03-1.24)). Higher social support was associated with better cognitive function (β coefficient per 1-SD increase in LSNS score; Modified Mini-Mental State Examination, 0.81 (95% CI, 0.44 to 1.19); Trail Making Test A & B, -2.53 (95% CI, -4.29 to -0.76) and -6.53 (95% CI, -10.07 to -2.99), respectively; Buschke Selective Reminder Test 1, 2, and 3, 0.19 (95% CI, 0.07 to 0.30); 1.59 (95% CI, 0.96 to 2.22); and 0.40 (95% CI, 0.23 to 0.56), respectively. Higher social support was associated with higher likelihood of being nonfrail (OR, 1.77; 95% CI per 1-SD higher LSNS score, 1.24-2.53). LIMITATIONS Conclusions about causality cannot be drawn from an observational cross-sectional study. CONCLUSIONS In older patients with CKD, higher social support was associated with higher health-related quality of life and cognitive function and less frailty.
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Affiliation(s)
- Anne Slaven
- Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Jesse Hsu
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey R. Schelling
- Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | | | | | | | | | - Eva Lustigova
- Department of Epidemiology, Tulane University, New Orleans, LA
| | - Xue Wang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - John Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Anna C. Porter
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mahboob Rahman
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Edward Horwitz
- Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - CRIC Study investigators
- Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- MetroHealth Medical Center, Cleveland, OH
- Renaissance Renal Research Institute; Detroit, MI
- Department of Epidemiology, Tulane University, New Orleans, LA
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
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Yangöz ŞT, Turan Kavradim S, Özer Z, Boz İ. Psychometric properties of the Kidney Disease Quality of Life-36 instrument: A systematic review using COSMIN methodology. Nurs Health Sci 2021; 23:792-806. [PMID: 34453394 DOI: 10.1111/nhs.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Abstract
The Kidney Disease Quality of Life-36 (KDQOL-36) is a multidimensional measure of the quality of life regarding physical and mental functions, kidney disease burden, symptoms and problems, and the effects of kidney disease on daily life, which is commonly used in clinical evaluations of patients with chronic kidney disease. We conducted a systematic review of the psychometric properties of the KDQOL-36, searching databases from 1994 to December 2020 and selecting 15 studies for independent assessments of methodological quality, measurement properties, and quality of evidence according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The KDQOL-36 demonstrated inconsistent, very low quality evidence for structural validity, internal consistency, reliability, and responsiveness, and inconsistent, low quality evidence for content validity and hypothesis testing. There was no evidence for cross-cultural validity or measurement error due to lack of relevant data. The findings indicate that this instrument is categorized as B according to COSMIN, and thus can be recommended for assessing the quality of life for patients with chronic kidney disease, but should be evaluated with further psychometric studies.
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Affiliation(s)
- Şefika Tuğba Yangöz
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University, Pamukkale, Turkey
| | - Selma Turan Kavradim
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Zeynep Özer
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Grams ME, Surapaneni A, Appel LJ, Lash JP, Hsu J, Diamantidis CJ, Rosas SE, Fink JC, Scialla JJ, Sondheimer J, Hsu CY, Cheung AK, Jaar BG, Navaneethan S, Cohen DL, Schrauben S, Xie D, Rao P, Feldman HI. Clinical events and patient-reported outcome measures during CKD progression: findings from the Chronic Renal Insufficiency Cohort Study. Nephrol Dial Transplant 2021; 36:1685-1693. [PMID: 33326030 PMCID: PMC8396398 DOI: 10.1093/ndt/gfaa364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) face risks of not only end-stage kidney disease (ESKD), cardiovascular disease (CVD) and death, but also decline in kidney function, quality of life (QOL) and mental and physical well-being. This study describes the multidimensional trajectories of CKD using clinical events, kidney function and patient-reported outcome measures (PROMs). We hypothesized that more advanced CKD stages would associate with more rapid decline in each outcome. METHODS Among 3939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, we evaluated multidimensional disease trajectories by G- and A-stages of enrollment estimated glomerular filtration rate (eGFR) and albuminuria, respectively. These trajectories included clinical events (ESKD, CVD, heart failure and death), eGFR decline and PROMs [kidney disease QOL (KDQOL) burden, effects and symptoms questionnaires, as well as the 12-item short form mental and physical component summaries]. We also evaluated a group-based multitrajectory model to group participants on the basis of longitudinal PROMs and compared group assignments by enrollment G- and A-stage. RESULTS The mean participant age was 58 years, 45% were women, mean baseline eGFR was 44 mL/min/1.73 m2 and median urine albumin:creatinine ratio was 52 mg/g. The incidence of all clinical events was greater and eGFR decline was faster with more advanced G- and A-stages. While baseline KDQOL and physical component measures were lower with more advanced G- and A-stage of CKD, changes in PROMs were inconsistently related to the baseline CKD stage. Groups formed on PROM trajectories were fairly distinct from existing CKD staging (observed agreement 60.6%) and were associated with the risk of ESKD, CVD, heart failure and death. CONCLUSIONS More advanced baseline CKD stage was associated with a higher risk of clinical events and faster eGFR decline, and was only weakly related to changes in patient-reported metrics over time.
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Affiliation(s)
- Morgan E Grams
- Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Aditya Surapaneni
- Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence J Appel
- Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jesse Hsu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sylvia E Rosas
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Julia J Scialla
- School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James Sondheimer
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Chi-Yuan Hsu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alfred K Cheung
- Veterans Affairs Salt Lake City Health Care System, University of Utah, Salt Lake City, UT, USA
| | - Bernard G Jaar
- Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Schrauben
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawei Xie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pandu Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Harold I Feldman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Anderson NE, McMullan C, Calvert M, Dutton M, Cockwell P, Aiyegbusi OL, Kyte D. Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study. BMJ Open 2021; 11:e052629. [PMID: 34446501 PMCID: PMC8395280 DOI: 10.1136/bmjopen-2021-052629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Patients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs) may help support tailored healthcare and improve outcomes. This study investigates the methodological basis for routine PRO assessment, particularly using electronic formats (ePROs), to maximise the potential of PRO use, through exploration of the experiences, views and perceptions of patients and healthcare professionals (HCPs) on implementation and use of PROs in haemodialysis settings. STUDY DESIGN Qualitative study. SETTING AND PARTICIPANTS Semistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK. ANALYTICAL APPROACH Transcripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis. RESULTS For effective implementation, the potential value of PROs needs to be demonstrated empirically to stakeholders. Any intervention must remain flexible enough for individual and aggregate use, measuring outcomes that matter to patients and clinicians, while maintaining operational simplicity. Any implementation must sit within a wider framework of education and support for both patients and clinicians who demonstrate varying previous experience of using PROs and often confuse related concepts. Implementation plans must recognise the multidimensionality of end-stage kidney disease and treatment by haemodialysis, while acknowledging the associated challenges of delivering care in a highly specialised environment. To support implementation, careful consideration needs to be given to barriers and facilitators including effective leadership, the role of champions, effective launch and ongoing evaluation. CONCLUSIONS Using the CFIR to explore the experiences, views and perceptions of key stakeholders, this study identified key factors at organisational and individual levels which could assist effective implementation of ePROs in haemodialysis settings. Further research will be required to evaluate subsequent ePRO interventions to demonstrate the impact and benefit to the dialysis community.
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Affiliation(s)
- Nicola Elzabeth Anderson
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
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128
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Worboys HM, Cooper NJ, Burton JO, Gray LJ. Measuring quality of life in trials including patients on dialysis: how are transplants and mortality incorporated into the analysis? A systematic review protocol. BMJ Open 2021; 11:e048179. [PMID: 34408045 PMCID: PMC8375767 DOI: 10.1136/bmjopen-2020-048179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION It is estimated that 25 000 people in the UK receive dialysis. Dialysis is an intrusive and time-consuming intervention that causes significant reductions in quality of life. When enrolled in a clinical trial, often some patients drop out of the study either because they die, receive a kidney transplant or are lost to follow-up for other reasons. It is unclear how these events are dealt with when analysing quality of life measures within clinical trials. This review will assess current practice for dealing with loss to follow-up in trials including patients on haemodialysis. The methods currently used will be analysed in terms of their adequacy and will form the basis of future work assessing the most appropriate methods to employ under these circumstances. The results of this review will feed into recommendations for future nephrology trials. METHODS AND ANALYSIS A systematic search of electronic databases including MEDLINE and the Cochrane Library will be conducted to find clinical trials enrolling patients on haemodialysis that measure quality of life using either the kidney disease quality of life (KDQoL) or the short form 36 health survey (SF-36) (or any variation of these two measures). Ongoing trials will be identified through a search of trial registers. Articles will be screened against inclusion/exclusion criteria and data will be extracted using a predetermined data extraction form. General information such as the title, location, trial design will be extracted along with more specific information on how the study dealt with patients that died or received a transplant before the end of the follow-up period. Two independent reviewers will perform screening and extraction. Disagreements will be resolved by discussion or by a third independent reviewer. Data synthesis will be performed as a narrative summary. ETHICS AND DISSEMINATION Ethics approval is not required. Dissemination will be by publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020223869.
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Affiliation(s)
- Hannah M Worboys
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Grandy S, Jackson J, Moon R, Bluff D, Palaka E. Health-related quality of life and lifestyle changes in patients with chronic kidney disease and hyperkalaemia: Real-world data from the US, five European countries and China. Int J Clin Pract 2021; 75:e14326. [PMID: 33960068 DOI: 10.1111/ijcp.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 10/26/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic kidney disease patients have impaired health-related quality of life and an increased risk of hyperkalaemia. AIMS The objective was to evaluate the impact of hyperkalaemia on health-related quality of life, and investigate lifestyle change recommendations, in these patients. METHODS The Adelphi Real World Chronic Kidney Disease Specific Programme™ was used. Data were collected from physicians and patients with non-dialysis dependent stage 3a, 3b and 4 chronic kidney disease from the US, France, Germany, Spain, Italy, the UK and China. Patients completed the Kidney Disease Quality of Life Instrument and EuroQol-5D-3L. Analyses compared data between hyperkalaemic (serum potassium >5.0 mmol/L) and normokalaemic (serum potassium 3.5-5.0 mmol/L) patients. RESULTS Overall, 1149 patients were included (hyperkalaemic: n = 216, normokalaemic: n = 933; US: n = 376, Europe: n = 490, China: n = 283). Hyperkalaemic vs normokalaemic patients experienced more symptoms (P < .001) and had numerically lower scores, indicating poorer health-related quality of life, in all Kidney Disease Quality of Life domains, with significant differences for three/five domains. Hyperkalaemic patients reported numerically lower EuroQol-5D-3L utility index and visual analogue scores, indicating poorer health status, than normokalaemic patients. A higher proportion of hyperkalaemic than normokalaemic patients were recommended to reduce dietary potassium (P < .05). More normokalaemic than hyperkalaemic patients reported making a radical change in five/six recommended lifestyle changes, with the difference significant for four/six recommendations. CONCLUSIONS Hyperkalaemia is associated with an incremental impairment of the health-related quality of life in chronic kidney disease patients. A better understanding of the impact of hyperkalaemia in these patients could improve patient outcomes.
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Affiliation(s)
- Susan Grandy
- Global Payer Evidence, AstraZeneca, Gaithersburg, MD, USA
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Komaba H, Zhao J, Yamamoto S, Nomura T, Fuller DS, McCullough KP, Evenepoel P, Christensson A, Zhao X, Alrukhaimi M, Al-Ali F, Young EW, Robinson BM, Fukagawa M. Secondary hyperparathyroidism, weight loss, and longer term mortality in haemodialysis patients: results from the DOPPS. J Cachexia Sarcopenia Muscle 2021; 12:855-865. [PMID: 34060245 PMCID: PMC8350219 DOI: 10.1002/jcsm.12722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Wasting is a common complication of kidney failure that leads to weight loss and poor outcomes. Recent experimental data identified parathyroid hormone (PTH) as a driver of adipose tissue browning and wasting, but little is known about the relations among secondary hyperparathyroidism, weight loss, and risk of mortality in dialysis patients. METHODS We included 42,319 chronic in-centre haemodialysis patients from the Dialysis Outcomes and Practice Patterns Study phases 2-6 (2002-2018). Linear mixed models were used to estimate the association between baseline PTH and percent weight change over 12 months, adjusting for country, demographics, comorbidities, and labs. Accelerated failure time models were used to assess 12 month weight loss as a mediator between baseline high PTH and mortality after 12 months. RESULTS Baseline PTH was inversely associated with 12 month weight change: 12 month weight loss >5% was observed in 21%, 18%, 18%, 17%, 15%, and 14% of patients for PTH ≥600 pg/mL, 450-600, 300-450, 150-300, 50-150, and <50 pg/mL, respectively. In adjusted analyses, 12 month weight change compared with PTH 150-299 pg/mL was -0.60%, -0.12%, -0.10%, +0.15%, and +0.35% for PTH ≥600, 450-600, 300-450, 50-150, and <50 pg/mL, respectively. This relationship was robust regardless of recent hospitalization and was more pronounced in persons with preserved appetite. During follow-up after the 12 month weight measure [median, 1.0 (interquartile range, 0.6-1.7) years; 6125 deaths], patients with baseline PTH ≥600 pg/mL had 11% [95% confidence interval (CI), 9-13%] shorter lifespan, and 18% (95% CI, 14-23%) of this effect was mediated through weight loss ≥2.5%. CONCLUSIONS Secondary hyperparathyroidism may be a novel mechanism of wasting, corroborating experimental data, and, among chronic dialysis patients, this pathway may be a mediator between elevated PTH levels and mortality. Future research should determine whether PTH-lowering therapy can limit weight loss and improve longer term dialysis outcomes.
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Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.,The Institute of Medical Sciences, Tokai University, Isehara, Japan
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | | | | | - Pieter Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Xinju Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Fadwa Al-Ali
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Eric W Young
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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131
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Wen J, Jin X, Al Sayah F, Short H, Ohinmaa A, Davison SN, Walsh M, Johnson JA. Mapping the Edmonton Symptom Assessment System-Revised: Renal to the EQ-5D-5L in patients with chronic kidney disease. Qual Life Res 2021; 31:567-577. [PMID: 34278540 DOI: 10.1007/s11136-021-02948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The Edmonton Symptom Assessment System-Revised: Renal (ESAS-r: Renal) is a disease-specific patient-reported outcome measure (PROM) that assesses symptoms common in chronic kidney disease (CKD). There is no preference-based scoring system for the ESAS-r: Renal or a mapping algorithm to predict health utility values. We aimed to develop a mapping algorithm from the ESAS-r: Renal to the Canadian EQ-5D-5L index scores. METHODS We used data from a multi-centre cluster randomized-controlled trial of the routine measurement and reporting of PROMs in hemodialysis units in Northern Alberta, Canada. In two arms of the trial, both the ESAS-r: Renal and the EQ-5D-5L were administered to CKD patients undergoing hemodialysis. We used data from one arm for model estimation, and data from the other for validation. We explored direct and indirect mapping models; model selection was based on statistical fit and predictive power. RESULTS Complete data were available for 506 patient records in the estimation sample and 242 in the validation sample. All models tended to perform better in patients with good health, and worse in those with poor health. Generalized estimating equations (GEE) and generalized linear model (GLM) on selected ESAS-r: Renal items were selected as final models as they fitted the best in estimation and validation sample. CONCLUSION When only ESAS-r: Renal data are available, one could use GEE and GLM to predict EQ-5D-5L index scores for use in economic evaluation. External validation on populations with different characteristics is warranted, especially where renal-specific symptoms are more prevalent.
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Affiliation(s)
- Jiabi Wen
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Hilary Short
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael Walsh
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Taylor K, Chu NM, Chen X, Shi Z, Rosello E, Kunwar S, Butz P, Norman SP, Crews DC, Greenberg KI, Mathur A, Segev DL, Shafi T, McAdams-DeMarco MA. Kidney Disease Symptoms before and after Kidney Transplantation. Clin J Am Soc Nephrol 2021; 16:1083-1093. [PMID: 34597266 PMCID: PMC8425607 DOI: 10.2215/cjn.19031220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n=190), and post-transplantation symptom score trajectories (mixed effects models). RESULTS At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (-0.06 points per month; 95% confidence interval, -0.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. CONCLUSIONS Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
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Affiliation(s)
- Kathryn Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhan Shi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen Rosello
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sneha Kunwar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Butz
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silas P. Norman
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Deidra C. Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Keiko I. Greenberg
- Department of Medicine, Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tariq Shafi
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Correspondence: Dr. Mara A. McAdams-DeMarco, Departments of Surgery and Epidemiology, Johns Hopkins, 615 North Wolfe Street, W6033, Baltimore, MD 21205.
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133
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Beaini C, Aoun M, El Hajj C, Sleilaty G, Haber N, Maalouf G, Abi Rached E. The impact of the SARS-CoV-2 pandemic on the mental health of hemodialysis patients in Lebanon. J Med Life 2021; 14:523-530. [PMID: 34621377 PMCID: PMC8485366 DOI: 10.25122/jml-2020-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Hemodialysis is a necessary treatment for end-stage kidney disease patients. It imposes undergoing three sessions of dialysis per week in a specialized center. Amid the SARS-CoV-2 pandemic, precautionary measures were mandatory in all dialysis facilities and may have negatively impacted patients' well-being. This study aimed to uncover the scale of this effect. We performed a cross-sectional study of all patients undergoing chronic hemodialysis in two dialysis units (one urban and another rural). Patients with Alzheimer's disease were excluded. Patients filled a questionnaire including information on socio-demographics, factors related to the dialysis facility, and the impact of the COVID-19 epidemic on their mental health. A total of 72 patients responded. Their median age was 70 (60.79) years. Of them, 68% were males, 71% were married, and 10% were living alone. Following the pandemic, 35% felt more anxious, with a higher incidence of anxiety in the rural unit (p=0.021). Half of them felt very limited in their relationships, and 29% were isolated from their families. In total, 98% of patients were satisfied with the staff support. The imposed preventive measures were perceived as very strict in 27% of the surveyed patients. The majority of the urban group were bothered for not eating during the session, and they felt significantly more stress than the rural group (p=0.001). The SARS-CoV-2 pandemic increased anxiety among hemodialysis patients from a rural setting. Stress was more prevalent in the urban group and most probably related to limitations in eating during sessions. The majority were satisfied with staff support.
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Affiliation(s)
- Chadia Beaini
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Nephrology, Bellevue Medical Center, Mansourieh, Lebanon
| | - Mabel Aoun
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon
| | - Chebli El Hajj
- Department of Nephrology, Bellevue Medical Center, Mansourieh, Lebanon
| | - Ghassan Sleilaty
- Department of Biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Cardiovascular Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Nicole Haber
- Administrative Department, Bellevue Medical Center, Mansourieh, Lebanon
| | - Ghassan Maalouf
- Administrative Department, Bellevue Medical Center, Mansourieh, Lebanon
| | - Eliane Abi Rached
- Department of Psychology, Bellevue Medical Center, Mansourieh, Lebanon
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134
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Flythe JE, Karlsson N, Sundgren A, Cordero P, Grandinetti A, Cremisi H, Rydén A. Development of a preliminary conceptual model of the patient experience of chronic kidney disease: a targeted literature review and analysis. BMC Nephrol 2021; 22:233. [PMID: 34162354 PMCID: PMC8220773 DOI: 10.1186/s12882-021-02440-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patient-reported outcome (PRO) instruments should capture the experiences of disease and treatment that patients consider most important in order to inform patient-centred care and product development. The aim of this study was to develop a preliminary conceptual model of patient experience in chronic kidney disease (CKD) based on a targeted literature review and to characterize existing PRO instruments used in CKD. Methods PubMed, EMBASE and Cochrane databases and recent society meetings were searched for publications reporting signs/symptoms and life impacts of CKD. Concepts identified in the literature review were used to develop a preliminary conceptual model of patient experience of CKD, overall, and within patient subpopulations of differing CKD causes, severities and complications. PRO instruments, identified from PRO databases, CKD literature and CKD clinical trials, were assessed for content validity, psychometric strength and coverage of concepts in the literature review. Results In total, 100 publications met criteria for analysis; 56 signs/symptoms and 37 life impacts of CKD were identified from these sources. The most frequently mentioned signs/symptoms were pain/discomfort (57% of publications) and tiredness/low energy/lethargy/fatigue (42%); the most commonly reported life impacts were anxiety/depression (49%) and decrements in physical functioning (43%). Signs/symptoms and life impacts varied across the subpopulations and were more frequent at advanced CKD stages. The preliminary conceptual model grouped signs/symptoms into seven domains (pain/discomfort; energy/fatigue; sleep-related; gastrointestinal-related; urinary-related; skin−/hair−/nails-related; and other) and life impacts into six domains (psychological/emotional strain; cognitive impairment; dietary habit disruption; physical function decrements; interference with social relationships; and other). Eleven PRO instruments were considered to be promising for use in CKD; all had limitations. Conclusions Although preliminary, the proposed conceptual model highlights key PROs for people with CKD and is intended to spur development of more tailored PRO instruments to assess these concepts. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02440-9.
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Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, 7024 Burnett-Womack CB #7155, Chapel Hill, NC, USA.
| | | | - Anna Sundgren
- Cardiovascular Renal & Metabolic late stage development, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Henry Cremisi
- US Medical Affairs, Renal, AstraZeneca, Wilmington, DE, USA
| | - Anna Rydén
- R&D Digital Health, AstraZeneca, Gothenburg, Sweden
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135
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Orozco-González CN, Márquez-Herrera RM, Cortés-Sanabria L, Cueto-Manzano AM, Gutiérrez-Medina M, Gómez-García EF, Rojas-Campos E, Paniagua-Sierra JR, Martín Del Campo F. Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients. Nefrologia 2021; 42:S0211-6995(21)00103-X. [PMID: 34154849 DOI: 10.1016/j.nefro.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022] Open
Abstract
Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.
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Affiliation(s)
- Claudia N Orozco-González
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico; Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Roxana M Márquez-Herrera
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Laura Cortés-Sanabria
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico.
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | | | - Erika F Gómez-García
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Enrique Rojas-Campos
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - José R Paniagua-Sierra
- Unidad de Investigación en Enfermedades Nefrológicas, Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, Mexico
| | - Fabiola Martín Del Campo
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
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136
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Wang Y, Snoep JD, Hemmelder MH, van der Bogt KEA, Bos WJW, van der Boog PJM, Dekker FW, de Vries APJ, Meuleman Y. Outcomes after kidney transplantation, let's focus on the patients' perspectives. Clin Kidney J 2021; 14:1504-1513. [PMID: 34084453 PMCID: PMC8162867 DOI: 10.1093/ckj/sfab008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 02/03/2023] Open
Abstract
Graft function and patient survival are traditionally the most used parameters to assess the objective benefits of kidney transplantation. Monitoring graft function, along with therapeutic drug concentrations and transplant complications, comprises the essence of outpatient management in kidney transplant recipients (KTRs). However, the patient's perspective is not always included in this process. Patients' perspectives on their health after kidney transplantation, albeit subjective, are increasingly acknowledged as valuable healthcare outcomes and should be considered in order to provide patient-centred healthcare. Such outcomes are known as patient-reported outcomes (PROs; e.g. health-related quality of life and symptom burden) and are captured using PRO measures (PROMs). So far, PROMs have not been routinely used in clinical care for KTRs. In this review we will introduce PROMs and their potential application and value in the field of kidney transplantation, describe commonly used PROMs in KTRs and discuss structural PROMs implementation into kidney transplantation care.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaapjan D Snoep
- Department of Internal Medicine, Tergooi, Hilversum, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen E A van der Bogt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J M van der Boog
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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137
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Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton JO, Dasgupta I, Farrington K, Ford I, Kalra PA, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the PEDAL RCT. Health Technol Assess 2021; 25:1-52. [PMID: 34156335 PMCID: PMC8256322 DOI: 10.3310/hta25400] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether or not clinically implementable exercise interventions in haemodialysis patients improve quality of life remains unknown. OBJECTIVES The PEDAL (PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease) trial evaluated the clinical effectiveness and cost-effectiveness of a 6-month intradialytic exercise programme on quality of life compared with usual care for haemodialysis patients. DESIGN We conducted a prospective, multicentre randomised controlled trial of haemodialysis patients from five haemodialysis centres in the UK and randomly assigned them (1 : 1) using a web-based system to (1) intradialytic exercise training plus usual-care maintenance haemodialysis or (2) usual-care maintenance haemodialysis. SETTING The setting was five dialysis units across the UK from 2015 to 2019. PARTICIPANTS The participants were adult patients with end-stage kidney disease who had been receiving haemodialysis therapy for > 1 year. INTERVENTIONS Participants were randomised to receive usual-care maintenance haemodialysis or usual-care maintenance haemodialysis plus intradialytic exercise training. MAIN OUTCOME MEASURES The primary outcome of the study was change in Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score (from baseline to 6 months). Cost-effectiveness was determined using health economic analysis and the EuroQol-5 Dimensions, five-level version. Additional secondary outcomes included quality of life (Kidney Disease Quality of Life Short Form, version 1.3, generic multi-item and burden of kidney disease scales), functional capacity (sit-to-stand 60 and 10-metre Timed Up and Go tests), physiological measures (peak oxygen uptake and arterial stiffness), habitual physical activity levels (measured by the International Physical Activity Questionnaire and Duke Activity Status Index), fear of falling (measured by the Tinetti Falls Efficacy Scale), anthropometric measures (body mass index and waist circumference), clinical measures (including medication use, resting blood pressure, routine biochemistry, hospitalisations) and harms associated with intervention. A nested qualitative study was conducted. RESULTS We randomised 379 participants; 335 patients completed baseline assessments and 243 patients (intervention, n = 127; control, n = 116) completed 6-month assessments. The mean difference in change in physical component summary score from baseline to 6 months between the intervention group and control group was 2.4 arbitrary units (95% confidence interval -0.1 to 4.8 arbitrary units; p = 0.055). Participants in the intervention group had poor compliance (49%) and very poor adherence (18%) to the exercise prescription. The cost of delivering the intervention ranged from £463 to £848 per participant per year. The number of participants with harms was similar in the intervention (n = 69) and control (n = 56) groups. LIMITATIONS Participants could not be blinded to the intervention; however, outcome assessors were blinded to group allocation. CONCLUSIONS On trial completion the primary outcome (Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score) was not statistically improved compared with usual care. The findings suggest that implementation of an intradialytic cycling programme is not an effective intervention to enhance health-related quality of life, as delivered to this cohort of deconditioned patients receiving haemodialysis. FUTURE WORK The benefits of longer interventions, including progressive resistance training, should be confirmed even if extradialytic delivery is required. Future studies also need to evaluate whether or not there are subgroups of patients who may benefit from this type of intervention, and whether or not there is scope to optimise the exercise intervention to improve compliance and clinical effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN83508514. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharlene A Greenwood
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jamie H Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Catherine Bulley
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | | | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | - Iain C Macdougall
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | | | | | - Chante Reid
- King's College Hospital NHS Foundation Trust, London, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maarten W Taal
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - David C Wheeler
- School of Medicine, University College London, London, UK
- George Institute for Global Health, Sydney, NSW, Australia
| | - Claire White
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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138
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Impact d’une prise en charge par hypnose sur le vécu et l’observances des recommandations hydriques en hémodialyse : résultats d’un protocole à cas unique chez deux patients. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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139
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Greenwood SA, Koufaki P, Macdonald JH, Bhandari S, Burton JO, Dasgupta I, Farrington K, Ford I, Kalra PA, Kean S, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. Randomized Trial-PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis. Kidney Int Rep 2021; 6:2159-2170. [PMID: 34386665 PMCID: PMC8343798 DOI: 10.1016/j.ekir.2021.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program. Methods In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded. Results We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: -0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments. Conclusions A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.
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Affiliation(s)
- Sharlene A Greenwood
- Renal Medicine, King's College Hospital NHS Trust, London, UK.,School of Renal Medicine, King's College London, London, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jamie H Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Wales, UK
| | - Sunil Bhandari
- Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Sharon Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Iain C Macdougall
- Renal Medicine, King's College Hospital NHS Trust, London, UK.,School of Renal Medicine, King's College London, London, UK
| | | | - Sandip Mitra
- Renal Medicine, Manchester University Hospitals, Manchester, UK
| | - Chante Reid
- Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maarten W Taal
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Peter C Thomson
- Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David C Wheeler
- Renal Medicine, University College London, London, UK.,The George Institute for Global Health, New South Wales, Australia
| | - Claire White
- Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Magdi Yaqoob
- Renal Medicine, The Royal London Hospital, London, UK
| | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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140
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Kim JH, Han JM, Kim H, Lee KB, Chung W, Kim YS, Park SK, Chae DW, Ahn C, Oh KH, Hyun YY. Low serum adiponectin level is associated with better physical health-related quality of life in chronic kidney disease. Sci Rep 2021; 11:10928. [PMID: 34035377 PMCID: PMC8149720 DOI: 10.1038/s41598-021-90339-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Hyperadiponectemia is paradoxically associated with renal disease progression and mortality in chronic kidney disease (CKD). Its association with health-related quality of life (HR-QOL) is unknown. This study aimed to verify the association between adiponectin and HR-QOL in Korean pre-dialysis CKD cohort. This cross-sectional study analyzed 1551 pre-dialysis CKD patients from KNOW-CKD (KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into three tertiles (T1–T3) according to adiponectin levels. HR-QOL was assessed using SF-36. High physical component summary (PCS) and mental component summary (MCS) were defined as highest quartile of each score. Multivariate logistic regression was used to analyze odds ratio (OR) and 95% confidence interval (CI) for high PCS and MCS. Prevalence of high PCS were 33.3%, 27.5%, and 17.0% and that of high MCS were 31.7%, 24.8%, and 21.3% for T1, T2, and T3 (both p for trend < 0.001). The adjusted OR [95% CI] of T1 and T2 in reference to T3 were 1.56 [1.09–2.23] and 1.19 [0.85–1.68] for high PCS and 1.19 [0.85–1.68] and 0.94 [0.68–1.29] for high MCS. Serum adiponectin level was inversely associated with physical HR-QOL in Korean pre-dialysis CKD patients. This relationship was independent of various cardiovascular risk factors.
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Affiliation(s)
- Ji Hye Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-Gu, Seoul, 03181, Republic of Korea
| | - Ji Min Han
- Jung Jaemyun Internal Medicine Clinic, Seoul, Republic of Korea
| | - Hyang Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-Gu, Seoul, 03181, Republic of Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-Gu, Seoul, 03181, Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Yong-Soo Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-Gu, Seoul, 03181, Republic of Korea.
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VITADIAL "Does correction of 25 OH-VITAmin D with cholecalciferol supplementation increase muscle strength in hemoDIALysis patients?": study protocol for a randomized controlled trial. Trials 2021; 22:364. [PMID: 34034786 PMCID: PMC8146204 DOI: 10.1186/s13063-021-05302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Muscle strength decreases as kidney failure progresses. Low muscle strength affects more than 50% of hemodialysis patients and leads to daily life activities impairment. In the general population, numerous studies have linked low 25OH-vitamin D (25OHD) concentrations to the loss of the muscle strength and low physical performances. Data on native vitamin D and muscle function are scarce in the chronic kidney disease (CKD) population, but low 25OHD levels have been associated with poor muscle strength. We present in this article the protocol of an ongoing study named VITADIAL testing if cholecalciferol supplementation in hemodialysis patients with low 25OHD improves their muscle strength. METHODS/DESIGN VITADIAL is a prospective open randomized French multicenter study. All patients will have 25OHD levels ≤50nmol/L at randomization. One group will receive 100,000 UI cholecalciferol once a month during 6 months; the other group will receive no treatment during 6 months. In order to randomize patients with 25OHD ≤50nmol/L, supplemented patients will undergo a 3 months wash-out period renewable 3 times (maximum of 12 months wash-out) until 25OHD reaches a level ≤50nmol/L. The main objective of this study is to analyze if a 6-month period of oral cholecalciferol (i.e., native vitamin D) supplementation improves muscle strength of hemodialysis patients with low 25OHD vitamin D levels. Muscle strength will be assessed at 0, 3, and 6 months, by handgrip strength measured with a quantitative dynamometer. Secondary objectives are (1) to analyze 25OHD plasma levels after vitamin D wash-out and/or supplementation, as well as factors associated with 25OHD lowering speed during wash-out, and (2) to analyze if this supplementation improves patient's autonomy, reduces frailty risk, and improves quality of life. Fifty-four patients are needed in each group to meet our main objective. DISCUSSION In the general population, around 30 randomized studies analyzed the effects of vitamin D supplementation on muscle strength. These studies had very different designs, sizes, and studied population. Globally, these studies and the meta-analysis of studies favor a beneficial effect of vitamin D supplementation on muscle strength, but this effect is mainly found in the subgroup of aged patients and those with the lowest 25OHD concentrations at inclusion. We reported a positive independent association between 25OHD and handgrip strength in a population of 130 hemodialysis patients in a dose-dependent manner. In our cohort, a plateau effect was observed above 75 nmol/L. Only two randomized studies analyzed the effect of native vitamin D supplementation on muscle strength in hemodialysis patients, but unfortunately, these two studies were underpowered. VITADIAL is a trial specifically designed to assess whether cholecalciferol might benefit to hemodialysis patient's muscle strength. TRIAL REGISTRATION ClinicalTrials.gov NCT04262934 . Registered on 10 February 2020 - Retrospectively registered.
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Woo K, Fuld R, Grandinetti A, Lawson J, Litchfield T, Ohan M, Peipert JD, Rivara MB, Roberts G, Roy-Chaudhury P, Underwood M, Nordyke RJ. Patient-reported outcomes in hemodialysis vascular access: A call to action. J Vasc Access 2021; 23:973-980. [PMID: 34032166 DOI: 10.1177/11297298211018295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While access-related dysfunction is a clear driver of clinical outcomes and costs, the full impact of vascular access dysfunction on patient experience and quality of life is not fully characterized in the literature. One way to more comprehensively characterize the patient experience from the patient perspective is through patient reported outcomes (PROs). However, the limited implementation of PROs in clinical trials, patient registries, quality measurement, and other research settings has significantly constrained the patient voice in evaluation of vascular access outcomes and vascular access decision-making. To address these issues, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the U.S. Food and Drug Administration, assembled an interdisciplinary workgroup to enhance uptake of access-related PROs with the aims of: (1) reviewing the domains of HRQOL that are affected by vascular access, collect information on existing instruments that measure access-specific HRQOL in hemodialysis, and identify gaps in existing measures; (2) identifying and critically assessing barriers to widespread use of access-specific PRO measures; and (3) defining initiatives to overcome barriers and make recommendations for strategies to improve the use and utility of access-specific PRO measures. A consensus group process identified potential barriers to use of PRO measures in six categories: (1) PRO misperceptions, (2) patient factors, (3) regulators and payers, (4) instrument factors, (5) study design, and (6) physicians. The workgroup provided recommendations for actions to promote the widespread utilization of vascular access-related PRO measures in five categories: (1) development of vascular access-specific PRO measures, (2) ensuring comprehensive assessment when using vascular access PRO measures, (3) ensuring accessibility and applicability of vascular access PRO measures to all end stage kidney disease populations, (4) establishing universal guidelines and accepted vascular access PRO measures, and (5) engaging stakeholders across all facets.
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Affiliation(s)
- Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert Fuld
- Dialysis Access Specialists, Mid Atlantic Nephrology Associates, Timonium, MD, USA
| | - Amanda Grandinetti
- Kidney Health Initiative Patient and Family Partnership Council, Elmhurst, IL, USA
| | | | | | - Mark Ohan
- WL Gore and Associates, Flagstaff, AZ, USA
| | | | - Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Glenda Roberts
- Kidney Research Institute/Center for Dialysis Innovation, University of Washington, Seattle, WA, USA
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Prischl FC, Rossing P, Bakris G, Mayer G, Wanner C. Major adverse renal events (MARE): a proposal to unify renal endpoints. Nephrol Dial Transplant 2021; 36:491-497. [PMID: 31711188 DOI: 10.1093/ndt/gfz212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In renal studies, various outcome endpoints are used with variable definitions, making it nearly impossible to perform meta-analyses and deduce meaningful conclusions. Increasing attention is directed towards standardization of renal outcome reporting. METHODS A working group was formed to produce a unifying definition of renal outcomes that can be used by all investigators. We propose major adverse renal events (MARE) as the term for a standardized composite of hard renal outcomes. We discuss the components for inclusion in MARE from existing evidence. RESULTS MARE could include three to five items, considered relevant to patients and regulators. New onset of kidney injury, that is persistent albuminuria/proteinuria and/or decreasing glomerular filtration rate (GFR) <60 ml/min/1.73 m2, persistent signs of worsening kidney disease, development of end-stage kidney disease with estimated GFR <15 ml/min/1.73 m2 without or with initiation of kidney replacement therapy, and death from renal cause are core items of MARE. Additionally, patient reported outcomes should be reported in parallel to MARE as a standard set of primary (or secondary) endpoints in studies on kidney disease of diabetic, hypertensive-vascular, or other origin. CONCLUSIONS MARE as a reporting standard will enhance the ability to compare studies and thus, facilitate meaningful meta-analyses. This will result in standardized endpoints that should result in guideline improvement to better individualize care of patients with kidney disease.
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Affiliation(s)
- Friedrich C Prischl
- Department of Nephrology, 4th Department of Internal Medicine, Klinikum WelsGrieskirchen, Wels, Austria
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago, Chicago, IL, USA
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Sheshadri A, Kittiskulnam P, Delgado C, Sudore RL, Lai JC, Johansen KL. Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention. Am J Nephrol 2021; 52:420-428. [PMID: 33979802 DOI: 10.1159/000516130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
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Affiliation(s)
- Anoop Sheshadri
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California, USA
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
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van der Willik EM, Terwee CB, Bos WJW, Hemmelder MH, Jager KJ, Zoccali C, Dekker FW, Meuleman Y. Patient-reported outcome measures ( PROMs): making sense of individual PROM scores and changes in PROM scores over time. Nephrology (Carlton) 2021; 26:391-399. [PMID: 33325638 PMCID: PMC8048666 DOI: 10.1111/nep.13843] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 01/30/2023]
Abstract
Patient-reported outcome measures (PROMs) are increasingly being used in nephrology care. However, in contrast to well-known clinical measures such as blood pressure, health-care professionals are less familiar with PROMs and the interpretation of PROM scores is therefore perceived as challenging. In this paper, we provide insight into the interpretation of PROM scores by introducing the different types and characteristics of PROMs, and the most relevant concepts for the interpretation of PROM scores. Concepts such as minimal detectable change, minimal important change and response shift are explained and illustrated with examples from nephrology care.
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Affiliation(s)
- Esmee M. van der Willik
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Epidemiology and Data ScienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Data ScienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Willem Jan W. Bos
- Department of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal MedicineSt. Antonius HospitalNieuwegeinThe Netherlands
| | - Marc H. Hemmelder
- Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Kitty J. Jager
- ERA‐EDTA Registry, Department of Medical InformaticsAmsterdam UMC, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Carmine Zoccali
- CNR‐IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and HypertensionReggio CalabriaItaly
| | - Friedo W. Dekker
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Yvette Meuleman
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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147
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Al Salmi I, Kamble P, Lazarus ER, D'Souza MS, Al Maimani Y, Hannawi S. Kidney Disease-Specific Quality of Life among Patients on Hemodialysis. Int J Nephrol 2021; 2021:8876559. [PMID: 33880190 PMCID: PMC8049780 DOI: 10.1155/2021/8876559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Quality of life (QoL) of hemodialysis patients can be examined in two aspects: kidney-specific quality of life and general quality of life. OBJECTIVE To determine the QoL among patients undergoing hemodialysis, to assess patients' QoL on hemodialysis, and to determine the factors associated with QoL among hemodialysis patients in Oman. METHOD A cross-sectional study was carried out with 205 patients to measure the QoL across various demographic and clinical variables in Oman. The Arabic version of the KDQOL-SFtool was used to collect data from patients undergoing hemodialysis to give QoL quantitative measures. RESULTS The physical-QoL was 45.7 (95% CI, 44.3, 47.0), which is less than half that of a healthy human. The emotional-QoL is 53.33 (95% CI, 51.1, 55.5), slightly more than half in a healthy human-QoL. The difference between physical and emotional-QoL scores is -7.66 (95% CI, -10.3, -5.1), showing that physical QoL is significantly less than emotional-QoL. The overall general QoL score was 49.5 (95% CI, 47.8, 51.2), half the QoL score of a healthy human. Younger patients are also more likely to experience emotional problems compared with older patients. Patients with 5-8 mg/l levels of serum creatinine have lower emotional wellbeing. People on low incomes experienced social difficulties, while the maximum burden was found in physical activities and minimum social function. CONCLUSION Both physical (45.7) and emotional (53.3) QoL scores in dialysis patients are nearly half those of an average human. Hence, there is a poor QoL among dialysis patients like other studies, and therefore, further improvement of renal rehabilitation in dialysis patients is warranted to improve patients' QoL.
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Affiliation(s)
- Issa Al Salmi
- The Royal Hospital, 23 July Street, P. O. Box 1331, Code 111, Muscat, Oman
| | - Pramod Kamble
- Senior Specialist Nephrologist, Royal Hospital Ministry of Health, Muscat, Oman
| | | | | | - Yaqoob Al Maimani
- Senior Nephrologist & Superintendent, Bowsher Dialysis Unit, Muscat, Oman
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Segura-Orti E, Koufaki P, Kouidi E. Bridging the gap from research to practice for enhanced health-related quality of life in people with chronic kidney disease. Clin Kidney J 2021; 14:ii34-ii42. [PMID: 33981418 PMCID: PMC8101625 DOI: 10.1093/ckj/sfaa268] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
Improving the health status of people with chronic kidney disease (CKD) through physical activity (PA) or exercise interventions is challenging. One of the gaps in the process of translating the general public PA activity guidelines as well as the CKD-specific guidelines into routine clinical practice is the lack of systematic recording and monitoring of PA and physical function attributes, which can also be used to develop individualized and measurable plans of action to promote PA for health. We aim to present an overview of key considerations for PA, physical function and health-related quality of life (HRQoL) evaluation in people with CKD, with the aim of encouraging health professionals to integrate assessment of these outcomes in routine practices. Physical inactivity and impaired physical function, sometimes to the extent of physical and social disability levels, and subsequently lower perceived HRQoL, are highly prevalent in this population. Enhanced PA is associated with better physical function that also translates into multiple health benefits. Breaking the vicious circle of inactivity and physical dysfunction as early as possible in the disease trajectory may confer huge benefits and enhanced life satisfaction in the longer term. With this in mind, the importance of PA/exercise interventions in CKD to improve HRQoL is also summarized.
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Affiliation(s)
- Eva Segura-Orti
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Pelagia Koufaki
- Centre for Health, Physical Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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149
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Ghahramani N, Chinchilli VM, Kraschnewski JL, Lengerich EJ, Sciamanna CN. Effect of Peer Mentoring on Quality of Life among CKD Patients: Randomized Controlled Trial. KIDNEY DISEASES 2021; 7:323-333. [PMID: 34395547 DOI: 10.1159/000514477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
Introduction CKD is associated with decreased quality of life (QOL). Peer mentoring (PM) leads to improved QOL in various chronic diseases. The effectiveness of PM on QOL of patients with CKD has not been previously studied. We conducted a randomized clinical trial to test the effectiveness of face-to-face (FTF) and online mentoring by trained peers, compared with usual care, on CKD patients' QOL. Methods We randomized 155 patients in one of 3 groups: (1) FTF PM (n = 52), (2) online PM (n = 52), and (3) textbook only (n = 51). Peer mentors were patients with CKD, who received formal training through 16 h of instruction. Participants in all 3 groups received a copy of an informational textbook about CKD. Participants assigned to PM received either 6 months of FTF or online PM. The outcomes included time-related changes in domain scores of the Kidney Disease Quality of Life (KDQOL)-36 for each of the groups over the 18-month study period. Results Compared with baseline, online PM led to improved scores in domains of the KDQOL-36 at 18 months: Effects of Kidney Disease (p = 0.01), Burden of Kidney Disease (p = 0.01), Symptoms and Problems of Kidney Disease (p = 0.006), SF-12 Physical Composite Summary (p = 0.001), and SF-12 Mental Composite Summary (p < 0.001). There were no statistically significant changes from baseline in domain scores of KDQOL-36 within the FTF PM and textbook-only groups. Conclusions Among patients with CKD, online PM led to increased scores in domains of the KDQOL-36 at 18 months. The study was limited to English-speaking subjects with computer literacy and internet access.
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Affiliation(s)
| | - Vernon M Chinchilli
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | | | - Eugene J Lengerich
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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150
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Smith G, Avenell A, Band MM, Hampson G, Lamb EJ, Littleford RC, McNamee P, Soiza RL, Sumukadas D, Witham MD. Associations between frailty, physical performance, and renal biomarkers in older people with advanced chronic kidney disease. Eur Geriatr Med 2021; 12:943-952. [PMID: 33730363 PMCID: PMC8463514 DOI: 10.1007/s41999-021-00478-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022]
Abstract
Aim To test whether renal biochemical markers were associated with physical performance and frailty in older people with advanced chronic kidney disease. Findings Biochemical markers associated with chronic kidney disease did not consistently associate with baseline physical performance or the rate of change of physical performance measures. Message Targeting improvements in renal biochemistry may not be a fruitful way to improve physical function and frailty in older people with advanced chronic kidney disease. Supplementary Information The online version of this article (10.1007/s41999-021-00478-4) contains supplementary material, which is available to authorized users. Purpose Impaired physical performance and frailty are common in older people with advanced chronic kidney disease but it is unclear which metabolic derangements contribute to these impairments. We, therefore, examined associations between renal biochemical markers and both physical performance and frailty in older people with advanced chronic kidney disease. Methods Secondary analysis of data from the BiCARB trial, which enrolled non-dialysing patients aged 60 and over, with chronic kidney disease stage 4/5, with serum bicarbonate < 22 mmol/L. Participants undertook the Short Physical Performance Battery, maximum grip strength and six-minute walk test at baseline, 3, 6, 12 and 24 months. Renal biochemistry (serum creatinine, cystatin C, phosphate, and bicarbonate), haemoglobin, 25-hydroxyvitamin D and NT-pro-B-type natriuretic peptide were measured at baseline. Associations between baseline renal biochemistry and physical performance, and between baseline biochemistry and the monthly rate of change in physical performance were assessed. Results We analysed data from 300 participants (mean age 74 years; 86 [29%] women). 148 (49%) were pre-frail, 86 (29%) were frail. In multivariable cross-sectional baseline analyses, only age and BMI were significantly associated with baseline short physical performance battery; age, sex, body mass index, NT-pro-BNP and 25-hydroxyvitamin D were significantly associated with baseline six-minute walk distance. No significant associations were found between biochemical markers and change in physical performance over time, except between baseline 25-hydroxyvitamin D concentration and change in six-minute walk distance. Conclusions Biochemical markers associated with chronic kidney disease did not consistently associate with baseline physical performance or the rate of change of physical performance measures. Trial Registration: ISRCTN09486651 Supplementary Information The online version of this article (10.1007/s41999-021-00478-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- George Smith
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Margaret M Band
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Geeta Hampson
- Department of Clinical Chemistry and Metabolic Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edmund J Lamb
- Pathology Department, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Roy L Soiza
- Ageing Clinical and Experimental Research, University of Aberdeen, Aberdeen, UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly, NHS Tayside, Dundee, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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