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Vovlianou S, Koutlas V, Ikonomou M, Vassilikopoulos T, Papoulidou F, Dounousi E. Quality of life of caregivers of end-stage kidney disease patients: Caregivers or care recipients? J Ren Care 2023; 49:56-72. [PMID: 34706151 DOI: 10.1111/jorc.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND End-stage kidney disease (ESKD) patients require specific and continuous care, which affects caregivers' quality of life (QOL). It is necessary to define the basic problems and restrictions upon family caregivers of renal patients affecting their physical and psychological status. OBJECTIVES The main objectives of this narrative review were to examine the literature over the past 10 years, to describe factors associated with QOL of caregivers of patients with ESKD, and to identify the level of subjective burden reported by caregivers. METHODS A literature search was carried out using the following electronic databases: PubMed, Medscape, Science Direct, Scopus, PsychINFO and other scientific sources. Keywords included 'quality of life', 'caregivers', 'end stage kidney or renal disease patients', 'burden' and a combination of these terms. Only studies from January 2010 to December 2020 were included in this study. RESULTS The results found that there was significant burden and distress experienced by caregivers that affected their QOL. Patients' QOL is associated with caregivers' QOL. The hours of caring per day and the long-term replacement therapy are associated with great burden. CONCLUSIONS More awareness to caregivers' QOL is required to meet their needs, reduce anxiety and to improve patients' QOL. Caregiver support could empower and prepare them for initiation of replacement therapy. This can potentially enhance their diseased family members' QOL and could also restrict the use of health care system resources. Given how difficult it is to conceptualize QOL, a holistic approach to patients and caregivers require QOL assessment in each stage of the kidney disease.
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Affiliation(s)
- Stavroula Vovlianou
- Department of Nephrology, Faculty of Medicine, University of Ioannina, Ioannina, Greece.,Department of Nephrology, General Hospital of Kavala, Kavala, Greece
| | - Vasilios Koutlas
- Department of Nephrology, Faculty of Medicine, University of Ioannina, Ioannina, Greece.,Department of Nephrology, University General Hospital of Ioannina, Ioannina, Greece
| | - Margarita Ikonomou
- Department of Nephrology, University General Hospital of Ioannina, Ioannina, Greece
| | - Theodore Vassilikopoulos
- Department of Nephrology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fani Papoulidou
- Department of Nephrology, General Hospital of Kavala, Kavala, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, University of Ioannina, Ioannina, Greece.,Department of Nephrology, University General Hospital of Ioannina, Ioannina, Greece
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2
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Using an international online forum to explore perspectives of caregivers of patients with chronic kidney disease. J Nephrol 2022; 35:267-277. [PMID: 35000136 DOI: 10.1007/s40620-021-01216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Caregivers of patients with chronic kidney disease (CKD) experience significant burden of care. Online forums provide an important platform for peer connection and expression of perspectives and concerns, but have not been used to capture consumer experiences in CKD research. Social support can improve caregivers' quality of life, with emerging research exploring online social support. METHOD This study employed qualitative content analysis to examine 159 posts on an online international forum: Caregivers of Patients with Kidney Disease to examine the experiences and concerns raised by caregivers of patients with CKD. Posts were coded using verbatim words and phrases, then arranged into three overarching themes, 12 categories and 71 sub-categories. RESULTS The overarching themes were Impact to Carer Wellbeing; Use of Online Social Support; Caregiver Knowledge. Online posts highlighted the psychological and physical challenges for caregivers of patients with CKD including social isolation, helplessness and the impact to paid employment. Participants used online social support to connect with peers and seek advice from the forum community on topics including: the patient's diet; clinical management; CKD symptoms; and how to support the patient to adhere to diet and medications. CONCLUSION This study provides valuable insight into gaps in caregiver knowledge and their need to seek online peer support. Caregiver forums can inform support strategies from healthcare professionals to increase caregiver involvement in treatment and education options, as well as tangible assistance to support caregivers' and patients' needs, such as transportation services for dialysis patients.
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3
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Hovadick AC, Jardim VR, Paúl C, Pagano A, Reis I, Torres H. Interventions to improve the well-being of family caregivers of patients on hemodialysis and peritoneal dialysis: a systematic review. PeerJ 2021; 9:e11713. [PMID: 34322322 PMCID: PMC8300494 DOI: 10.7717/peerj.11713] [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] [Received: 04/02/2020] [Accepted: 06/10/2021] [Indexed: 01/23/2023] Open
Abstract
Background The family caregivers of patients on hemodialysis (HD) and peritoneal dialysis (PD) typically experience higher burden than the general population because of the nature of tasks these caregivers need to carry out as a part of homecare. This fact influences both the caregivers’ quality of life and the quality of their care toward the patient. Thus, this study aimed to review the effectiveness and limitations of interventions in improving the well-being of family caregivers of patients on HD and PD. Methodology A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, VHL Regional Portal, Scopus, and Web of Science databases were searched queried for randomized controlled trials that developed interventions aimed at improving the well-being of family caregivers of patients undergoing HD and/or PD from 2009 to 2020. The study protocol was registered at the International Prospective Register of Systematic Reviews (registration no. CRD42020151161). Results Six studies met the inclusion criteria, all of which addressed caregivers of patients undergoing HD. All interventions reported in the included studies were carried out in group sessions, which addressed topics such as patient assistance and care, treatment complications, coping strategies, caregiver self-care practices, problem solving, and self-efficacy. The studies found significant improvement in the caregiver’s well-being. Conclusions Group session interventions are effective in improving the well-being of family caregivers of patients undergoing HD. In regard to PD, there is insufficient evidence to make recommendations for caregivers of patients with this treatment.
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Affiliation(s)
- Ana Carolina Hovadick
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Viviane Rodrigues Jardim
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Constança Paúl
- Instituto de Ciências Biomédicas Abel Salazar, Universidade de Porto, Porto, Portugal
| | - Adriana Pagano
- Faculdade de Letras, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ilka Reis
- Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Heloisa Torres
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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4
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Rastogi A, Lerma EV. Anemia management for home dialysis including the new US public policy initiative. Kidney Int Suppl (2011) 2021; 11:59-69. [PMID: 33777496 PMCID: PMC7983021 DOI: 10.1016/j.kisu.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) requiring kidney replacement therapy are often treated in conventional dialysis centers at substantial cost and patient inconvenience. The recent United States Executive Order on Advancing American Kidney Health, in addition to focusing on ESKD prevention and reforming the kidney transplantation system, focuses on providing financial incentives to promote a shift toward home dialysis. In accordance with this order, a goal was set to have 80% of incident dialysis patients receiving home dialysis or a kidney transplant by 2025. Compared with conventional in-center therapy, home dialysis modalities, including both home hemodialysis and peritoneal dialysis, appear to offer equivalent or improved mortality, clinical outcomes, hospitalization rates, and quality of life in patients with ESKD in addition to greater convenience, flexibility, and cost-effectiveness. Treatment of anemia, a common complication of chronic kidney disease, may be easier to manage at home with a new class of agents, hypoxia-inducible factor-prolyl hydroxylase inhibitors, which are orally administered in contrast to the current standard of care of i.v. iron and/or erythropoiesis-stimulating agents. This review evaluates the clinical, quality-of-life, economic, and social aspects of dialysis modalities in patients with ESKD, including during the coronavirus disease 2019 pandemic; explores new therapeutics for the management of anemia in chronic kidney disease; and highlights how the proposed changes in Advancing American Kidney Health provide an opportunity to improve kidney health in the United States.
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Affiliation(s)
- Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Edgar V. Lerma
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Section of Nephrology, Oak Lawn, Illinois, USA
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Jacquet S, Trinh E. The Potential Burden of Home Dialysis on Patients and Caregivers: A Narrative Review. Can J Kidney Health Dis 2019; 6:2054358119893335. [PMID: 31897304 PMCID: PMC6920584 DOI: 10.1177/2054358119893335] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose of review: Home dialysis modalities offer several benefits for patients with end-stage
kidney disease when compared with facility-based thrice-weekly hemodialysis.
To increase uptake of home dialysis, many centers are encouraging a
“home-first” approach. However, it is important to appreciate that “one size
may not fit all” and that dialysis modality selection is a complex decision
that needs to be individualized. The purpose of this review was to explore
aspects associated with home dialysis that may be associated with burden for
patients and their caregivers and to discuss strategies to alleviate these
concerns. Sources of information: Original research articles were identified from PubMed using search terms
“peritoneal dialysis,” “home hemodialysis,” “home dialysis,” “barriers,”
“quality of life” and “burden.” Methods: We performed a focused narrative review examining potential sources of burden
with home dialysis therapies after conducting a critical appraisal of the
literature and identifying the major recurring themes. Key findings: Home dialysis is associated with burden for certain patients. Indeed, some
patients may experience ongoing concerns regarding the risks of adverse
events and of inadequately performing dialysis on their own. Psychosocial
issues affecting quality of life may also arise and include fear of social
isolation, sleep disturbances, perceived financial burden, anxiety, and
fatigue. Patients who depend on a caregiver may worry about creating a
stressful home environment for their close ones. Furthermore, the demands
associated with being a caregiver may lead to psychosocial distress in the
caregivers themselves. All these factors may lead to burnout and
consequently, therapy discontinuation necessitating an unplanned transition
to in-center hemodialysis leading to adverse outcomes. However, certain
strategies may help alleviate burden especially if concerns are identified
early on. Limitations: As we did not apply any formal tool to assess the quality of the studies
included, selection bias may have occurred. Nonetheless, we have attempted
to provide a comprehensive review on the topic using numerous diverse
studies and extensive review of the literature. Implications: Future studies should focus on better identifying patient priorities and
strategies to facilitate dialysis modality selection and improve quality of
life.
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Affiliation(s)
- Sabriella Jacquet
- Division of Nephrology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Emilie Trinh
- Division of Nephrology, McGill University Health Centre, McGill University, Montreal, QC, Canada
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Gray NA, Zuo L, Hong D, Smyth B, Jun M, De Zoysa J, Vo K, Howard K, Wang J, Lu C, Liu Z, Cass A, Perkovic V, Jardine M. Quality of life in caregivers compared with dialysis recipients: The Co-ACTIVE sub-study of the ACTIVE dialysis trial. Nephrology (Carlton) 2019; 24:1056-1063. [PMID: 30723975 DOI: 10.1111/nep.13530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2018] [Indexed: 02/05/2023]
Abstract
AIM To compare quality of life (QOL) of caregivers of dialysis patients with the cared for patients and population norms. METHODS The ACTIVE Dialysis study randomized participants to extended (median 24 h/week) or standard (median 12 h/week) haemodialysis hours for 12 months. A subgroup of participants and their nominated caregivers completed QOL questionnaires including the EuroQOL-5 Dimension-3 Level (EQ5D-3 L), short form-36 (SF-36, also allowing estimation of the SF-6D), as well as a bespoke questionnaire and the personal wellbeing index (PWI). Caregiver QOL was compared with dialysis patient QOL and predictors of caregiver QOL were determined using multivariable regression. RESULTS There were 54 patients and caregiver pairs, predominantly from China. Caregivers mean (SD) age was 53.4 (11.3) years, 60% were female, 71% cared for their spouse/partner, and 36% were educated to university level. Caregivers had better physical but similar mental QOL compared with dialysis patients (mean SF-36 physical component summary: 46.9 ± 8.7 vs 40.4 ± 10.2, P < 0.001; mental component summary: 47.8 ± 9.7 vs 49.6 ± 12.0, P = 0.84). Health utility measured with EQ5D-3 L was not significantly different between caregivers and dialysis patients (mean 0.869 ± 0.185 vs 0.798 ± 0.227, P = 0.083). Caregiver PWI was 43.7 ± 15.5, significantly lower than the Chinese population norm (68.2 ± 14.2, P < 0.001). Higher physical and mental QOL among caregivers was predicted by university education but not age, gender or daily hours caring. CONCLUSION Caregivers have higher physical and equivalent mental QOL to dialysis patients but poorer personal well-being than the Chinese population. University education predicts better QOL and may be a surrogate for socioeconomic or other factors. (NCT00649298).
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Affiliation(s)
- Nicholas A Gray
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- The University of Queensland, Sunshine Coast Clinical School, Birtinya, Queensland, Australia
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Daqing Hong
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Renal Department, Sichuan Provincial People's Hospital, Chengdu, China
- University of Electronic Science and Technology of China Medical School, Chengdu, China
| | - Brendan Smyth
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Janak De Zoysa
- Renal Service, North Shore Hospital, Waitemata DHB, Auckland, New Zealand
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kha Vo
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, NSW Health, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jing Wang
- Department of Nephrology, First Affiliated Hospital of Dalain Medical University, Dalain, China
| | - Chunlai Lu
- Department of Nephrology, Shanghai 85th Hospital, Shanghai, China
| | - Zhangsuo Liu
- Department of Nephrology, First Affiliated Hospital of Zhengzhou University, China
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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7
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Ren Q, Lian M, Liu Y, Thomas-Hawkins C, Zhu L, Shen Q. Effects of a transtheoretical model-based WeChat health education programme on self-management among haemodialysis patients: A longitudinal experimental intervention study. J Adv Nurs 2019; 75:3554-3565. [PMID: 31441525 DOI: 10.1111/jan.14182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
AIM To examine the effects of a transtheoretical model-based WeChat health education programme on self-management in haemodialysis patients in China. DESIGN A longitudinal experimental intervention study. METHODS Patients (N = 120) who underwent haemodialysis from December 2015-November 2017 were recruited and randomly allocated to either group 1 (who received a 3-month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrolment in the study). Self-management, knowledge and self-efficacy were assessed at baseline (T0 ), 3 months after enrolment in the study (T1 ), 21 months after enrolment in the study (T2 ). RESULTS There were significant group effects on self-efficacy; time effects on partnership, self-care, emotion management with total self-management; interaction effects on problem-solving and emotion management within total self-management according to the two-way repeated measures ANCOVA. Further between-group comparisons indicated that patients in group 1 had better self-management than those in group 2 at T1 . Within-group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self-management at T1 ; however, group 2 had improved self-management at T2 . CONCLUSION The transtheoretical model-based WeChat health education programme had a potentially positive effect on improving the self-management of haemodialysis patients. IMPACT Self-management is often difficult yet crucial for haemodialysis patients. This study indicated that the transtheoretical model-based WeChat health education resulted in improved self-management in haemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self-management in patients. TRIAL REGISTRATION ChiCTR1800018172.
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Affiliation(s)
- Qingli Ren
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China.,Nursing College, Shanxi Medical University, Taiyuan, China
| | - Minling Lian
- Kidney Medical Ward, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yang Liu
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
| | | | - Lixia Zhu
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qu Shen
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
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Gilbertson EL, Krishnasamy R, Foote C, Kennard AL, Jardine MJ, Gray NA. Burden of Care and Quality of Life Among Caregivers for Adults Receiving Maintenance Dialysis: A Systematic Review. Am J Kidney Dis 2018; 73:332-343. [PMID: 30454885 DOI: 10.1053/j.ajkd.2018.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/16/2018] [Indexed: 01/11/2023]
Abstract
RATIONALE & OBJECTIVE Dialysis is a burdensome and complex treatment for which many recipients require support from caregivers. The impact of caring for people dependent on dialysis on the quality of life of the caregivers has been incompletely characterized. STUDY DESIGN Systematic review of quantitative studies of quality of life and burden to caregivers. SETTING & STUDY POPULATION Caregivers of adults receiving maintenance dialysis. SELECTION CRITERIA FOR STUDIES The Cochrane Library, Embase, PsycINFO, CINAHL, PubMed, and MEDLINE were systematically searched from inception until December 2016 for quantitative studies of caregivers. Pediatric and non-English language studies were excluded. Study quality was assessed using a modified Newcastle-Ottawa scale. DATA EXTRACTION 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTICAL APPROACH Descriptive reports of demographics, measurement scales, and outcomes. Quantitative meta-analysis using random effects when possible. RESULTS 61 studies were identified that included 5,367 caregivers from 21 countries and assessed the impact on caregivers using 70 different scales. Most (85%) studies were cross-sectional. The largest identified group of caregivers was female spouses who cared for recipients of facility-based hemodialysis (72.3%) or peritoneal dialysis (20.6%). Caregiver quality of life was poorer than in the general population, mostly comparable with caregivers of people with other chronic diseases, and often better than experienced by the dialysis patients cared for. Caregiver quality of life was comparable across dialysis modalities. LIMITATIONS Heterogeneity in study design and outcome measures made comparisons between studies difficult and precluded quantitative meta-analysis. Study quality was generally poor. CONCLUSIONS Quality of life of caregivers of dialysis recipients is poorer than in the general population and comparable to that of caregivers of individuals with other chronic diseases. The impact of caring for recipients of home hemodialysis or changes in the impact of caring over time have not been well studied. Further research is needed to optimally inform dialysis programs how to educate and support caregivers.
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Affiliation(s)
- Elise L Gilbertson
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Celine Foote
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia; Concord and Repatriation General Hospital, Concord, New South Wales, Australia
| | - Alice L Kennard
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Meg J Jardine
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia; Concord and Repatriation General Hospital, Concord, New South Wales, Australia
| | - Nicholas A Gray
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland.
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