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Duan DF, Zhou XL, Yan Y, Li YM, Hu YH, Li Q, Peng X, Gu Q, Li XY, Feng H, Tang AJ, Liu P, Xu HH, Liao RX, Ma DY. Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis. Ren Fail 2024; 46:2349121. [PMID: 38916144 PMCID: PMC11207921 DOI: 10.1080/0886022x.2024.2349121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. METHODS The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. RESULTS In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. CONCLUSIONS This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.
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Affiliation(s)
- Di-fei Duan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xue-li Zhou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yu Yan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | | | - Yan-hua Hu
- Jianyang People’s Hospital, Nanchang, China
| | - Qin Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiang Peng
- Panzhihua Central Hospital, Panzhihua, China
| | - Qin Gu
- West China Hospital, Sichuan University (for Huaxi Hospital in Meishan People’s Hospital), Chengdu, China
| | - Xiao-ying Li
- Xiquan People’s Hospital of Gansu Province, Lanzhou, China
| | - Hui Feng
- The Fifth People’s Hospital of Chengdu, Chengdu, China
| | | | - Pan Liu
- The Second People’s Hospital of Chengdu, Chengdu, China
| | - Hui-hui Xu
- The First People’s Hospital of Jiujiang City, Jiujiang, China
| | - Ruo-xi Liao
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Deng-yan Ma
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Andersen‐Hollekim T, Hole T, Solbjør M. Exploring Healthcare Paradoxes in Hospital Haemodialysis-A Qualitative Study. Health Expect 2024; 27:e70000. [PMID: 39212122 PMCID: PMC11362838 DOI: 10.1111/hex.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION The complex logics of healthcare systems inherit paradoxes that can lead to interpersonal conflicts impacting both patients and professionals. In this study, we aimed to identify and explore tensions and conflicts arising from paradoxes within hospital haemodialysis. METHODS We conducted a secondary supplementary analysis to previously collected qualitative data, including individual interviews with 11 patients and 10 nephrologists and focus groups involving a total of 13 haemodialysis nurses. Data were collected in Norway through three primary studies focused on exploring experiences of patient participation. For the current study, we employed thematic analysis. RESULTS Patient-professional conflicts emerged in three fundamental areas: (1) the hospital haemodialysis treatment, in which patients' views of treatment diverged from those of professionals, (2) patient-professional responsibility that became a negotiation point, with differing views on responsibilities, and (3) time, in which professional time took precedence over patients' time, indirectly impacting patients due to resource allocation. These conflicts stemmed from paradoxes driven by unevenly validated principles, conflict of interest, and conceptual ambiguity. CONCLUSION Altering healthcare logics by bringing in new perspectives or clarifying conceptual ambiguity could mitigate patient-professional conflicts. However, changing existing healthcare logics may give rise to new paradoxes and conflicts, which health services at various levels must address. PATIENT OR PUBLIC CONTRIBUTION This secondary analysis utilized previously collected data from a project that did not involve patient or public contribution.
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Affiliation(s)
- Tone Andersen‐Hollekim
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Torstein Hole
- Medical Department, Ålesund Hospital, Møre og Romsdal Hospital Trust, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
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Riehl-Tonn VJ, Ahmed SB. Care of Older Persons With Kidney Failure: Incorporating Values, Preferences, … and Dialysis? Ann Intern Med 2024; 177:1281-1282. [PMID: 39159458 DOI: 10.7326/m24-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Affiliation(s)
- Victoria J Riehl-Tonn
- Cumming School of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, and Women's and Children's Health Research Institute, Edmonton, Alberta, Canada; Alberta Kidney Disease Network, Alberta, Canada; and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Jin H, Fang W, Wang L, Zang X, Deng Y, Wu G, Li Y, Chen X, Wang N, Jiang G, Guo Z, Wang X, Qi Y, Lv S, Ni Z. A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD. Kidney Int Rep 2024; 9:2627-2634. [PMID: 39291207 PMCID: PMC11403029 DOI: 10.1016/j.ekir.2024.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. Methods This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. Results The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P = 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P = 0.388), peritonitis-free survival rates (P = 0.335), and patient survival rates (P = 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P = 0.001), whereas the duration of the first hospital stay showed no significant difference (P = 0.424). Conclusion For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.
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Affiliation(s)
- Haijiao Jin
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Molecular Cell Laboratory for Kidney Disease, Shanghai, China
- Shanghai Peritoneal Dialysis Research Center, Shanghai, China
- Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Molecular Cell Laboratory for Kidney Disease, Shanghai, China
- Shanghai Peritoneal Dialysis Research Center, Shanghai, China
- Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Wang
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Molecular Cell Laboratory for Kidney Disease, Shanghai, China
- Shanghai Peritoneal Dialysis Research Center, Shanghai, China
- Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiujuan Zang
- Department of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Yueyi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guoqing Wu
- Department of Nephrology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang China
| | - Ying Li
- Department of Nephrology, Central Hospital of Shanghai Jiading District, Shanghai, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gengru Jiang
- Department of Nephrology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyong Guo
- Department of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaoxia Wang
- Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghui Qi
- Department of Nephrology, Shanghai Punan Hospital, Shanghai, China
| | - Shifan Lv
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Molecular Cell Laboratory for Kidney Disease, Shanghai, China
- Shanghai Peritoneal Dialysis Research Center, Shanghai, China
- Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Molecular Cell Laboratory for Kidney Disease, Shanghai, China
- Shanghai Peritoneal Dialysis Research Center, Shanghai, China
- Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shen Y. CVVHDF combined with cytokine adsorption column ameliorates severe catheter-related bloodstream infection in a hemodialysis patient. SAGE Open Med Case Rep 2024; 12:2050313X241272670. [PMID: 39185073 PMCID: PMC11342434 DOI: 10.1177/2050313x241272670] [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: 01/02/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
In extracorporeal circulation, inflammatory mediators are eliminated through inflammatory cytokine adsorption. By interacting with inflammatory cytokines and removing them from the bloodstream, the adsorber's adsorbent lowers levels of inflammatory mediators and the inflammatory response. We present the case of a 67-year-old Chinese man diagnosed with sepsis due to a bloodstream infection from a catheter. We promptly utilized a cytokine adsorption column in conjunction with continuous veno-venous hemodiafiltration (CVVHDF), resulting in a decrease in interleukin-6 levels and complete removal of bascteria from the bloodstream. A critical turning point in illness management is reached as the levels of inflammatory cytokines drop and the dosage of patients' vasoactive medications improves significantly. In hemodialysis patients with secondary septic shock in the context of catheter-associated bacteremia, the combination of CVVHDF with cytokine adsorption therapy in hemodialysis may be clinically useful and improve or accelerate the patient's improvement.
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Affiliation(s)
- Yingjing Shen
- Department of Nephrology, Shanghai Tianyou Hospital, Shanghai, China
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6
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O'Hara P, Alzayer H, Harris L, Gorey D, McMonagle E, Madden M, Elhassan E, Reddan D, Casserly L, Leavey S, Conlon P. Kidney failure amongst Irish Travellers. Ir J Med Sci 2024:10.1007/s11845-024-03769-4. [PMID: 39088162 DOI: 10.1007/s11845-024-03769-4] [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: 04/09/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The occurrence of Kidney Failure with Replacement Therapy (KFRT) amongst Irish Travellers has not been well described. This study aims to determine the burden of KFRT amongst the Irish Traveller population and identify determinants of health amongst this cohort which may differ from the general population in Ireland. METHODS This retrospective cohort study included self-identifying Irish Travellers with KFRT registered in the National Kidney Disease Clinical Patient Management System between 1995 and 2022. KFRT was defined as Chronic Kidney Disease stage 5 (CKD G5) treated by dialysis or CKD G1-G5 after transplantation. The primary outcome measure was the prevalence of KFRT in Irish Travellers. Secondary exploratory outcomes included age at diagnosis, family history, biopsy diagnosis, kidney replacement therapy (KRT) modality, time to initiation of KRT, primary vascular access used, and time to receive a kidney transplant. RESULTS Four of six Irish hospital groups participated in the study. A total of 38 patients were identified as Irish Travellers with KFRT, with a crude prevalence rate of KFRT of 0.12% (CI 0.084-0.161, 95%) or 11.9 per 10,000 Irish Travellers. The mean age for diagnosis of kidney disease was 43 (SD, 20.8) and at commencement of KRT was 45 (SD, 20.9) years. A biopsy-proven diagnosis was provided in 24%. Twenty-two per cent was diagnosed with polycystic kidney disease or congenital anomalies of the kidney and urinary tract. The predominant modality for KRT was haemodialysis (89%), with central venous catheters being the most common initial vascular access (79%). Kidney transplants occurred in 45% of those studied, with a mean waiting time of 1.96 (SD, 1.6) years. CONCLUSIONS The Irish Traveller community have similar prevalence of KFRT when compared to the national prevalence, with a short time interval from diagnosis to commencement of KRT. They are less likely to avail of home therapies but have comparable wait times to the national waiting time to receive a kidney transplant.
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Affiliation(s)
- Paul O'Hara
- Department of Nephrology, Galway University Hospitals, Galway, Ireland.
| | - Husam Alzayer
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
- Medical Affairs, Prince Mohammed Medical City, Sakaka, Aljouf, Saudi Arabia
| | - Luke Harris
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - David Gorey
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Edward McMonagle
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Michelle Madden
- Department of Nephrology, University Hospital Waterford, Waterford, Ireland
| | | | - Donal Reddan
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
| | - Liam Casserly
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Sean Leavey
- Department of Nephrology, University Hospital Waterford, Waterford, Ireland
| | - Peter Conlon
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
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7
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Shrestha S, Haq K, Malhotra D, Patel DM. Care of Adults with Advanced Chronic Kidney Disease. J Clin Med 2024; 13:4378. [PMID: 39124645 PMCID: PMC11313041 DOI: 10.3390/jcm13154378] [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: 06/10/2024] [Revised: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Chronic kidney disease (CKD) impacts over 10% of the global population. Adults with CKD face significant morbidity and mortality. As kidney disease progresses, the risk of adverse outcomes increases. Here, we present an overview of strategies to care for adults with advanced CKD (stage 4-5 CKD, not receiving kidney replacement therapy). We aim to guide clinicians through several aspects of CKD care, ranging from recommended laboratory assessments to interdisciplinary support for patients as they plan for kidney replacement therapy (dialysis, transplantation, or conservative management). We incorporate considerations of health equity and person-centered care, empowering clinicians to deliver high-quality care to people with CKD.
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Affiliation(s)
| | | | | | - Dipal M. Patel
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (D.M.)
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Morin C, Pichette M, Elftouh N, Imbeault B, Laurin LP, Lafrance JP, Goupil R, Nadeau-Fredette AC. Is health-related quality of life trajectory associated with dialysis modality choice in advanced chronic kidney disease? Perit Dial Int 2024; 44:254-264. [PMID: 38186013 DOI: 10.1177/08968608231217807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Patients with advanced chronic kidney disease have lower health-related quality of life (HRQOL) than the general population. There is uncertainty regarding patterns of HRQOL changes before dialysis initiation. This study aimed to characterise HRQOL trajectory and assess its potential association with intended dialysis modality. METHODS This prospective single-centre cohort study followed adults with an estimated glomerular filtration rate ≤15 mL/min/1.73 m2 for one year. Patients were allocated into one of two groups based on their intended treatment modality, 'home dialysis' (peritoneal dialysis or home haemodialysis (HD)) and 'other' (in-centre HD or conservative care). Follow-up was for up to 1 year or earlier if initiated on kidney replacement therapy or died. Kidney Disease Quality of Life - Short Form (KDQOL-SF) was completed every 6 months. Predictors of changes in KDQOL-SF components were modelled using mixed effect multivariable linear regressions. RESULTS One hundred and nine patients were included. At baseline, crude physical composite summary (PCS) (45 ± 10 vs. 39 ± 8) was higher in patients choosing home dialysis (n = 41), while mental composite summary (MCS) was similar in both groups. After adjustment, patients choosing home dialysis had an increase in MCS (B = 8.4 per year, p = 0.007) compared to those selecting in-centre HD/conservative care. This translates into an annual increase in MSC by 3 points for the 'home dialysis' group, compared to an annual decline by 5.4 points in the 'other' group. There was no difference in PCS trajectory through time. CONCLUSIONS Patients choosing home dialysis had improved MCS over time compared to those not selecting home dialysis. More work is needed to determine how differences in processes of care and/or unmeasured patient characteristics modulate this association.
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Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Maude Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Benoit Imbeault
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Department of pharmacology and physiology, Université de Montréal, Montreal, QC, Canada
| | - Rémi Goupil
- Research Center, Sacré-Cœur Hospital, Montreal, QC, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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Damery S, Lambie M, Williams I, Coyle D, Fotheringham J, Solis-Trapala I, Allen K, Potts J, Dikomitis L, Davies SJ. Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England. Perit Dial Int 2024; 44:265-274. [PMID: 38445495 DOI: 10.1177/08968608241232200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Disparities in home dialysis uptake across England suggest inequity and unexplained variation in access. We surveyed staff at all English kidney centres to identify patterns in service organisation/delivery and explore correlations with home therapy uptake, as part of a larger study ('Inter-CEPt'), which aims to identify potentially modifiable factors to address observed variations. METHODS Between June and September 2022, staff working at English kidney centres were surveyed and individual responses combined into one centre-level response per question using predetermined data aggregation rules. Descriptive analysis described centre practices and their correlation with home dialysis uptake (proportion of new home dialysis starters) using 2019 UK Renal Registry 12-month home dialysis incidence data. RESULTS In total, 180 responses were received (50/51 centres, 98.0%). Despite varied organisation of home dialysis services, most components of service delivery and practice had minimal or weak correlations with home dialysis uptake apart from offering assisted peritoneal dialysis and 'promoting flexible decision-making about dialysis modality'. Moderate to strong correlations were identified between home dialysis uptake and centres reporting supportive clinical leadership (correlation 0.32, 95% Confidence Interval (CI): 0.05-0.55), an organisational culture that values trying new initiatives (0.57, 95% CI: 0.34-0.73); support for reflective practice (0.38, 95% CI: 0.11-0.60), facilitating research engagement (0.39, 95% CI: 0.13-0.61) and promoting continuous quality improvement (0.29, 95% CI: 0.01-0.53). CONCLUSIONS Uptake of home dialysis is likely to be driven by organisational culture, leadership and staff attitudes, which provide a supportive clinical environment within which specific components of service organisation and delivery can be effective.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Lambie
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - David Coyle
- NIHR Devices for Dignity, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James Fotheringham
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jessica Potts
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | - Simon J Davies
- Renal Research Group, School of Medicine, Keele University, Keele, UK
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Hasley HL, Iarajuli T, Nguyen J, Thiemann D, Malik M, Roth J, Raver M, Stifelman M, Munver R, Ahmed M, Yerram N. Race-modified estimated glomerular filtration rate underestimates chronic kidney disease prevalence in Black patients undergoing partial and radical nephrectomy: Implications for surgical planning. Urol Ann 2024; 16:221-226. [PMID: 39290227 PMCID: PMC11404712 DOI: 10.4103/ua.ua_7_24] [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: 01/19/2024] [Revised: 01/27/2024] [Accepted: 05/16/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction In estimated glomerular filtration rate equations (eGFR), the race multiplier (RM) yields greater eGFR values and may assign less severe chronic kidney disease (CKD) stages to black individuals. When deciding on appropriateness for partial nephrectomy (PN), patients with CKD are often considered a relative or absolute indication. We hypothesize that the eGFR RM may have ramifications for patients being counseled for radical nephrectomy (RN) versus PN to manage their renal tumor. Methods We utilized prospective and retrospective, IRB-approved single-center databases to select patients who underwent PN or RN between 2016 and 2022. Demographics, preoperative risk factors, preoperative eGFR, and surgical management were collected. Descriptive statistics and two-tailed difference of proportion tests compared the percentage of patients with CKD who underwent nephrectomy. Results This cohort included 1137 patients who underwent RN or PN, including 74 (6.5%) Black patients and 93.5% (n = 1063) non-Black patients. There was no statistically significant difference between the eGFR of Black and non-Black individuals using the Modification of Diet in Renal Disease equation (P = 0.24) or Chronic Kidney Disease Epidemiology Collaboration 2009 (CKD-EPI 2009) (P = 0.45); however, there was statistically significant difference in eGFR between sample populations when using CKD-EPI 2021 (P = 0.0055). Of the Black patient cohort, 16.2% of patients reclassified to a worse CKD class using CKD-EPI 2021, including 9.5% of Black patients reclassified to CKD3a or worse, and 14.6% of all patients (Black and non-Black) reclassified to a different CKD class under the CKD-EPI 2021 equation. Conclusions There are quantitative differences in the evaluation of eGFR when utilizing different equations that may impact clinical considerations and health equity outcomes for nephrectomy across racial groups.
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Affiliation(s)
- Hunter L Hasley
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Teona Iarajuli
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Jennifer Nguyen
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Daniel Thiemann
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Martin Malik
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Jacquelyn Roth
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Michael Raver
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Stifelman
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Ravi Munver
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nitin Yerram
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
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11
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Castaño I, Romero-González G, Arias M, Vega A, Deira J, Molina P, Ojeda R, Maduell F. Individualisation and challenges for haemodialysis in the next decade. Nefrologia 2024; 44:459-464. [PMID: 39216979 DOI: 10.1016/j.nefroe.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/11/2023] [Indexed: 09/04/2024] Open
Affiliation(s)
| | | | - Marta Arias
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Pablo Molina
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - Raquel Ojeda
- Hospital Universitario Reina Sofía, Córdoba, Spain
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12
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Morisi N, Montani M, Ehode EN, Virzì GM, Perrone S, Malaguti V, Ferrarini M, Donati G. Evaluating Short-Term Outcomes of Tunneled and Non-Tunneled Central Venous Catheters in Hemodialysis. J Clin Med 2024; 13:3664. [PMID: 38999230 PMCID: PMC11242506 DOI: 10.3390/jcm13133664] [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: 05/30/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The necessity of using central venous catheters (CVCs) in hemodialysis, coupled with their associated complications, remains a critical concern in nephrology. This study aims to compare the short-term prognosis of tunneled (T-CVC) and non-tunneled (NT-CVC) CVCs in acute hemodialysis patients, specifically focusing on infection rates, malpositioning, and lumen thrombosis within the first three weeks post-insertion. Methods: A retrospective analysis was conducted on 176 CVCs placed between January and December 2023 at the Policlinico di Modena and the Ospedale Civile di Baggiovara. Patient demographics, CHA2DS2-VASc scores, and comorbid conditions were recorded at the time of catheter placement. Outcomes assessed included catheter-related infections, malpositioning, and lumen thrombosis. Statistical analyses, including Chi-square tests, Fisher's exact tests, and Kaplan-Meier survival analysis, were performed to evaluate differences between T-CVCs and NT-CVCs. Results: The sample comprised 43% females with a mean age of 69.3 years (SD 13.9) and a mean CHADS-VASC score of 3.72 (SD 1.4). Hypertension (90%) was the most prevalent comorbidity. Of the 176 CVCs, 127 were T-CVCs and 49 were NT-CVCs. Infection rates were 3.15% for T-CVCs and 8.16% for NT-CVCs (p = 0.07). Malpositioning occurred in 0.79% of T-CVCs and 4.08% of NT-CVCs (p = 0.47). There was one case of lumen thrombosis in the NT-CVC group. Kaplan-Meier analysis indicated a significant divergence in infection-related catheter survival favoring T-CVCs after ten days (p = 0.034). Conclusions: While non-tunneled CVCs do not significantly alter short-term prognosis compared to tunneled CVCs, the latter show a better infection-related survival rate beyond ten days. Therefore, primary insertion of T-CVCs may be preferable when resources and clinical conditions permit, although NT-CVCs remain a viable option when immediate T-CVC insertion is challenging.
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Affiliation(s)
- Niccolò Morisi
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41126 Modena, Italy
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
| | - Martina Montani
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41126 Modena, Italy
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
| | - Edwidge Ntouba Ehode
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41126 Modena, Italy
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
| | - Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Salvatore Perrone
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
| | - Vittoria Malaguti
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
| | - Marco Ferrarini
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Gabriele Donati
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41126 Modena, Italy
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41121 Modena, Italy
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13
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Kim YH, Kim Y, Ha N, Cho JH, Kim YS, Kang SW, Kim NH, Yang CW, Kim YL, Lee JP, Lee W, Oh HJ. The effect of dialysis modality on annual mortality: A prospective cohort study. Sci Rep 2024; 14:14035. [PMID: 38890469 PMCID: PMC11189506 DOI: 10.1038/s41598-024-64914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.
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Affiliation(s)
- Yae Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonjin Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Nayoung Ha
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chul Woo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea Seoul St Mary's Hospital, Seoul, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Woojoo Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
| | - Hyung Jung Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Nephrology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
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14
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Qi Y, Zhang W, Wang J. A comparison of urgent-start of hemodialysis vs urgent initiation of peritoneal dialysis: a meta-analysis study. Int Urol Nephrol 2024; 56:2031-2043. [PMID: 38191865 DOI: 10.1007/s11255-023-03904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To investigate the effects of urgent-start HD(USHD) and urgent-start PD(USPD) on dialysis patients and provide references for relevant clinical practice. METHODS A literature search was conducted in Chinese and English databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP) and the cutoff date for which was July 30, 2023. Studies comparing USHD and USPD were included and I2 statistics and Q tests were used to determine heterogeneity among them. Risk ratios (RR) with 95% confidence intervals (CI) were computed for count data. RESULTS Nine studies met the inclusion criteria. The all-cause mortality rate was 0.173 (0.070, 0.277) for USPD versus 0.214 (0.142, 0.286) for USHD, indicating that USPD had a protective effect against all-cause mortality compared to USHD (RR = 0.76, 95% CI 0.63-0.91). Patients receiving USPD had lower risks of infection-related mortality (RR = 0.19; 95% CI 0.05-0.76), bacteremia (RR = 0.38; 95% CI 0.18-0.80), and composite complications (RR = 0.54; 95% CI 0.41-0.71). However, no significant differences were found between USHD and USPD for cardiovascular mortality (RR = 0.68; 95% CI 0.28-1.68) or cancer mortality (RR = 0.44; 95% CI 0.15-1.29). CONCLUSION Compared to USHD, USPD has better protective effects against all-cause mortality, infection-related mortality, bacteremia, and composite complications. However, more high-quality research is still needed to further investigate the impacts of the two dialysis modalities on patients.
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Affiliation(s)
- Yuanyuan Qi
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China
| | - Wenkai Zhang
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China
| | - Juanli Wang
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China.
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15
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Giles HE, Parameswaran V, Lasky R, Ficociello LH, Mullon C, Chatoth DK, Kraus M, Anger MS. Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States. Clin J Am Soc Nephrol 2024; 19:723-731. [PMID: 38373051 PMCID: PMC11168828 DOI: 10.2215/cjn.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Key Points This is the largest analysis of incident automated peritoneal dialysis (PD) prescriptions conducted in the United States to date. There was limited variability of automated PD prescriptions across the first 4 months of therapy. PD prescriptions tailored to meet the dialysis needs and lifestyle of patients may make PD a more attractive choice and increase longevity on PD. Background Changes in health care policies and recognition of patient benefit have contributed to increases in home-based dialysis, including peritoneal dialysis (PD). Frequent monitoring and early individualization of PD prescriptions are key prerequisites for the delivery of high-quality PD. The present analysis aimed to assess variations in PD prescriptions among incident automated PD (APD) patients who remain on PD for 120+ days. Methods This retrospective analysis examined data from patients within a large dialysis organization that initiated PD with APD between 2015 and 2019. PD prescription data were described by calendar year, timing of PD, and residual renal function categories. Changes in prescriptions from PD initiation (day 1) to day 120 were assessed descriptively. Results The cohort included 11,659 patients. The mean age at PD initiation increased from 2015 (56 [15] years) through 2019 (58 [15] years), whereas most other variables demonstrated no clear temporal change. Most patients (86%) had nighttime PD prescribed, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6–9.5) hours. Relative to day 1 nighttime prescriptions, there were (1 ) small increases in the proportion of patients receiving three or fewer cycles per day and those receiving 6+ cycles per day, (2 ) a 100 ml mean increase in fill volume per exchange, and (3 ) a mean 0.5 L increase in total nighttime treatment volume at day 120. When changes in nighttime APD prescriptions were examined at the patient level, 49% of patients had day 120 prescriptions that were unchanged from their initial prescription. Conclusions In the largest analysis of incident APD prescriptions conducted in the United States to date, most patients were prescribed nocturnal PD only with limited variability across the first 4 months of therapy.
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Affiliation(s)
- Harold E. Giles
- Nephrology Associates PC, Birmingham, Alabama
- Fresenius Medical Care Birmingham Home Clinic, Birmingham, Alabama
| | | | - Rachel Lasky
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | | | - Claudy Mullon
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Dinesh K. Chatoth
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Michael Kraus
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Michael S. Anger
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
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16
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Mehta K, Hussein WF, Leuther KK, Fegler A, Schiller B, Bennett PN. The experiences of people starting haemodialysis: A qualitative study. J Ren Care 2024. [PMID: 38734873 DOI: 10.1111/jorc.12496] [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: 12/28/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Starting dialysis is a life-changing transition for people living with kidney disease. People feel overwhelmed with diet changes, medications and surgical interventions, and often experience high levels of anxiety, depression and hospital admissions. The objective of this study was to explore and describe the experiences and perspectives of people starting dialysis. STUDY DESIGN Observational qualitative study using audio-recorded, individual, semi-structured interviews. PARTICIPANTS We conducted 20 semi-structured interviews with English-speaking adults who were within 90 days of starting in-centre haemodialysis at centres of a nonprofit dialysis provider in Northern California. APPROACH Trained qualitative researchers conducted interviews that were deidentified and transcribed verbatim before being inductively coded into codes, categories, and themes. RESULTS Three overarching themes emerged from the interviews. Being overwhelmed when starting dialysis, realises the emotional unpreparedness of patients starting dialysis and how the centre's environment (waiting and treatment areas) and staff behaviour impact the dialysis start experience. Making sense of it all, covers how the patient's symptoms, behaviour, and dialysis-related experiences impact the dialysis start. Moving forward, describes how education informed optimal decision-making, and can provide hope for a longer and better life. LIMITATIONS Predominantly college-educated participants were recruited from a single dialysis organisation which may limit the transferability of results. CONCLUSION Understanding the life-changing experiences that patients encounter when starting dialysis assist dialysis clinicians to help patients adjust and develop long-term coping strategies.
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Affiliation(s)
- Kshama Mehta
- Satellite Healthcare, Inc., San Jose, California, USA
- ImCare Biotechnology, Doylestown, Pennsylvania, USA
| | - Wael F Hussein
- Satellite Healthcare, Inc., San Jose, California, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kerstin K Leuther
- Satellite Healthcare, Inc., San Jose, California, USA
- Department of Clinical Research, University of Jamestown, Jamestown, North Dakota, USA
| | | | - Brigitte Schiller
- Satellite Healthcare, Inc., San Jose, California, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Paul N Bennett
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
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17
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Ghimire A, Shah S, Chauhan U, Ibrahim KS, Jindal K, Kazancioglu R, Luyckx VA, MacRae JM, Olanrewaju TO, Quinn RR, Ravani P, Shah N, Thompson S, Tungsanga S, Vachharanjani T, Arruebo S, Caskey FJ, Damster S, Donner JA, Jha V, Levin A, Malik C, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas. BMC Nephrol 2024; 25:159. [PMID: 38720263 PMCID: PMC11080121 DOI: 10.1186/s12882-024-03593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. METHODS Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. RESULTS Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). CONCLUSIONS High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Samveg Shah
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Utkarsh Chauhan
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kwaifa Salihu Ibrahim
- Nephrology Unit, Department of Medicine, Wuse District Hospital, Abuja, Nigeria
- Department of Internal Medicine, College of Health Sciences, Federal Capital Territory, Nile University, Abuja, Nigeria
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Timothy O Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robert R Quinn
- Departments of Medicine & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tushar Vachharanjani
- Department of Medicine, John D. Dingell Veterans Affairs Medical Center, Wayne State University School of Medicine, Detroit, MI, USA
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Nephrology and Hypertension, University of Cape Town, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, The University of Queensland, Woolloongabba, Queensland, Australia
- Translational Research Institue, University of Queensland, Queensland, Brisbane, Australia
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18
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Desbiens LC, Bargman JM, Chan CT, Nadeau-Fredette AC. Integrated home dialysis model: facilitating home-to-home transition. Clin Kidney J 2024; 17:i21-i33. [PMID: 38846416 PMCID: PMC11151120 DOI: 10.1093/ckj/sfae079] [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] [Received: 09/03/2023] [Indexed: 06/09/2024] Open
Abstract
Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care "burnout," clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.
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Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Joanne M Bargman
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
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19
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Koch-Weser S, Kennefick K, Tighiouart H, Wong JB, Gordon EJ, Isakova T, Rifkin D, Rossi A, Weiner DE, Ladin K. Development and Validation of the Rating of CKD Knowledge Among Older Adults (Know-CKD) With Kidney Failure. Am J Kidney Dis 2024; 83:569-577. [PMID: 38070590 DOI: 10.1053/j.ajkd.2023.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 01/27/2024]
Abstract
RATIONALE & OBJECTIVE Few older adults with kidney failure engage in shared decision making (SDM) for kidney replacement therapy. The lack of instruments to assess SDM-relevant knowledge domains may contribute to this. We assessed the reliability and validity of a new instrument, the Rating of CKD Knowledge Older Adults (Know-CKD). STUDY DESIGN Multistage process, including a stakeholder-engaged development phase, pilot testing, and validation of a knowledge instrument using a cross-sectional survey of older adults with CKD. SETTING & PARTICIPANTS 363 patients aged 70+years with nondialysis advanced chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2) in Boston, Chicago, Portland, ME, and San Diego from June 2018 and January 2020. EXPOSURE Educational level, higher literacy (Single Item Literacy Screener [SILS]) and numeracy (Subjective Numeracy Scale [SNS]), having participated in clinic-sponsored dialysis education, and self-reported "feeling informed" about options for treatment. OUTCOME Validity and reliability of the Know-CKD instrument. ANALYTICAL APPROACH Reliability was assessed with the Kuder-Richardson-20 coefficient. Construct validity was demonstrated by testing a priori hypotheses using t test, analysis of variance (ANOVA) tests, and linear regression analyses. RESULTS The mean (± SD) participant age was 77.6±5.9 years, and mean eGFR was 22.7±7.2mL/min/1.73m2; 281 participants (78%) self-reported as White. The 12-item Know-CKD assessment had good reliability (Kuder-Richardson-20 reliability coefficient=0.75), and a mean score of 58.2% ± 22.3 SD. The subscales did not attain acceptable reliability. The proportion answering correctly on each item ranged from 20.1% to 91.7%. In examining construct validity, the hypothesized associations held; Know-CKD significantly associated with higher education (β=6.98 [95% CI, 1.34-12.61], P=0.02), health literacy (β = -12.67 [95% CI, -19.49 to-5.86], P≤0.001), numeracy per 10% higher (β=1.85 [95% CI, 1.02-2.69], P≤0.001), and attendance at dialysis class (β=18.28 [95% CI, 13.30-23.27], P≤0.001). These associations were also observed for the subscales except for prognosis (not associated with literacy or numeracy). LIMITATIONS Know-CKD is only available in English and has been used only in research settings. CONCLUSIONS For older adults facing dialysis initiation decisions, Know-CKD is a valid, reliable, and easy to administer measure of knowledge. Further research should examine the relationship of kidney disease knowledge and SDM, patient satisfaction, and clinical outcomes. PLAIN-LANGUAGE SUMMARY The Rating of CKD Knowledge Among Older Adults (Know-CKD) study measures knowledge of chronic kidney disease (CKD) and is designed for older adults. Most existing knowledge measures for CKD focus on people of all ages and all CKD stages. This measure is useful because it will allow researchers to assess how well patient education efforts are working. Patient education is a way to help patients make decisions about their care. We describe how the measure was developed by a team of doctors, researchers, and patients, and how the measure performed among persons with advanced CKD aged 70 years and older. Know-CKD can inform efforts to improve shared decision-making research and practice for older patients with kidney disease.
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Affiliation(s)
- Susan Koch-Weser
- Department of Public Health & Community Medicine, School of Medicine, Tufts University, Boston
| | - Kristen Kennefick
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Hocine Tighiouart
- Tufts Clinical and Translational Science Institute, School of Medicine, Tufts University, Boston; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dena Rifkin
- Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Daniel E Weiner
- William B Schwartz MD Division of Nephrology, Tufts Medical Center, Boston
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts.
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20
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Slon-Roblero MF, Sanchez-Alvarez JE, Bajo-Rubio MA. Personalized peritoneal dialysis prescription-beyond clinical or analytical values. Clin Kidney J 2024; 17:i44-i52. [PMID: 38846417 PMCID: PMC11151113 DOI: 10.1093/ckj/sfae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 06/09/2024] Open
Abstract
Traditionally, dialysis adequacy has been assessed primarily by determining the clearance of a single small solute, urea. Nevertheless, it has become increasingly evident that numerous other factors play a crucial role in the overall well-being, outcomes and quality of life of dialysis patients. Consequently, in recent years, there has been a notable paradigm shift in guidelines and recommendations regarding dialysis adequacy. This shift represents a departure from a narrow focus only on the removal of specific toxins, embracing a more holistic, person-centered approach. This new perspective underscores the critical importance of improving the well-being of individuals undergoing dialysis while simultaneously minimizing the overall treatment burden. It is based on a double focus on both clinical outcomes and a comprehensive patient experience. To achieve this, a person-centered approach must be embraced when devising care strategies for each individual. This requires a close collaboration between the healthcare team and the patient, facilitating an in-depth understanding of the patient's unique goals, priorities and preferences while striving for the highest quality of care during treatment. The aim of this publication is to address the existing evidence on this all-encompassing approach to treatment care for patients undergoing peritoneal dialysis and provide a concise overview to promote a deeper understanding of this person-centered approach.
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Affiliation(s)
- María Fernanda Slon-Roblero
- Department of Nephrology, Hospital Universitario de Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | - J Emilio Sanchez-Alvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Gijón, Spain
| | - Maria Auxiliadora Bajo-Rubio
- Department of Nephrology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Hospital de la Princesa, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Madrid, Spain
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21
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Slon-Roblero MF. Fostering a future of home dialysis: transforming kidney care in Europe. Clin Kidney J 2024; 17:i1-i2. [PMID: 38846412 PMCID: PMC11151112 DOI: 10.1093/ckj/sfae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- María Fernanda Slon-Roblero
- Department of Nephrology, Hospital Universitario de Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra) Pamplona, Navarra, Spain
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22
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Weiner DE, Delgado C, Flythe JE, Forfang DL, Manley T, McGonigal LJ, McNamara E, Murphy H, Roach JL, Watnick SG, Weinhandl E, Willis K, Berns JS. Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:636-647. [PMID: 37972814 DOI: 10.1053/j.ajkd.2023.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023]
Abstract
Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.
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Affiliation(s)
| | - Cynthia Delgado
- San Francisco Veterans Affairs Health Care System and the University of California, San Francisco, CA
| | | | | | | | | | | | | | | | - Suzanne G Watnick
- Northwest Kidney Centers, Seattle, WA; University of Washington, Seattle, WA; Puget Sound VA, Seattle, WA
| | - Eric Weinhandl
- University of Minnesota, Minneapolis, MN; Satellite Healthcare, San Jose, CA
| | | | - Jeffrey S Berns
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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23
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Hoang AT, Nguyen PA, Phan TP, Do GT, Nguyen HD, Chiu IJ, Chou CL, Ko YC, Chang TH, Huang CW, Iqbal U, Hsu YH, Wu MS, Liao CT. Personalised prediction of maintenance dialysis initiation in patients with chronic kidney disease stages 3-5: a multicentre study using the machine learning approach. BMJ Health Care Inform 2024; 31:e100893. [PMID: 38677774 PMCID: PMC11057266 DOI: 10.1136/bmjhci-2023-100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Optimal timing for initiating maintenance dialysis in patients with chronic kidney disease (CKD) stages 3-5 is challenging. This study aimed to develop and validate a machine learning (ML) model for early personalised prediction of maintenance dialysis initiation within 1-year and 3-year timeframes among patients with CKD stages 3-5. METHODS Retrospective electronic health record data from the Taipei Medical University clinical research database were used. Newly diagnosed patients with CKD stages 3-5 between 2008 and 2017 were identified. The observation period spanned from the diagnosis of CKD stages 3-5 until the maintenance dialysis initiation or a maximum follow-up of 3 years. Predictive models were developed using patient demographics, comorbidities, laboratory data and medications. The dataset was divided into training and testing sets to ensure robust model performance. Model evaluation metrics, including area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and F1 score, were employed. RESULTS A total of 6123 and 5279 patients were included for 1 year and 3 years of the model development. The artificial neural network demonstrated better performance in predicting maintenance dialysis initiation within 1 year and 3 years, with AUC values of 0.96 and 0.92, respectively. Important features such as baseline estimated glomerular filtration rate and albuminuria significantly contributed to the predictive model. CONCLUSION This study demonstrates the efficacy of an ML approach in developing a highly predictive model for estimating the timing of maintenance dialysis initiation in patients with CKD stages 3-5. These findings have important implications for personalised treatment strategies, enabling improved clinical decision-making and potentially enhancing patient outcomes.
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Affiliation(s)
- Anh Trung Hoang
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Thanh Phuc Phan
- International PhD program of Biotech and Healthcare Management,College of Management, Taipei Medical University, Taipei, Taiwan
- University Medical Center, Ho Chi Minh City, Vietnam
| | - Gia Tuyen Do
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Huu Dung Nguyen
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Hanoi, Vietnam
| | - I-Jen Chiu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Ko
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chia-Te Liao
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
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24
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El Shamy O, Abra G, Chan C. Patient-Centered Home Hemodialysis: Approaches and Prescription. Clin J Am Soc Nephrol 2024; 19:517-524. [PMID: 37639246 PMCID: PMC11020435 DOI: 10.2215/cjn.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
Writing a home hemodialysis (HD) prescription is a complex, multifactorial process that requires the incorporation of patient values, preferences, and lifestyle. Knowledge of the different options available for home HD modality (conventional, nocturnal, short daily, and alternate nightly) is also important when customizing a prescription. Finally, an understanding of the different home HD machines currently approved for use at home and their different attributes and limitations helps guide providers when formulating their prescriptions. In this review article, we set out to address these different aspects to help guide providers in providing a patient-centered home HD approach.
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Affiliation(s)
- Osama El Shamy
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Graham Abra
- Satellite Healthcare, San Jose, California
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Christopher Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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25
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Sathiavageesan S, Murugan S. Accelerated neuropathy among chronic kidney disease patients undergoing hemodialysis: Analysis of an institutional cluster. Hemodial Int 2024; 28:188-197. [PMID: 38449056 DOI: 10.1111/hdi.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Accelerated neuropathy is a rare syndrome of rapidly worsening peripheral neuropathy, typically described in end-stage kidney disease (ESKD) patients undergoing dialysis. In our center, we encountered a surge in the occurrence of accelerated neuropathy among ESKD patients undergoing hemodialysis, which prompted systematic research. METHODS In this case-control study, we present the clinical features, electrophysiologic findings, and outcome of a series of patients who developed accelerated neuropathy after commencing hemodialysis for ESKD. Those who initiated hemodialysis and did not develop accelerated neuropathy were included as controls. We used logistic regression to identify predictors of accelerated neuropathy. RESULTS Among 436 ESKD patients who initiated hemodialysis over 4 years, 17 were diagnosed with accelerated neuropathy. The median-time (interquartile range) from hemodialysis initiation to presentation with accelerated neuropathy was 3 weeks (2-6). It typically presented as acute onset of unsteadiness of gait necessitating assistance for ambulation. Electrophysiology revealed length-dependent symmetric sensorimotor axonal neuropathy. Diabetes mellitus (odds ratio [OR] 4.1, 95% CI 1.2-13.9, p = 0.02), pre-existing peripheral neuropathy (OR 9.25, 95% CI 2.79-30.6, p < 0.001), and serum alkaline phosphatase (OR 1.2 for every 10 U increase, 95% CI 1.00-1.52, p = 0.04) significantly predicted accelerated neuropathy. With continued dialysis and supportive care, neurologic status improved, total-neuropathy score (summary score of peripheral nerve dysfunction incorporating clinical and electrophysiological parameters) declined from 26.5 to 18.4 (p < 0.001) and most regained unassisted ambulation. CONCLUSION This study presents the largest series of patients with accelerated neuropathy and has identified predictors. However, in view of the unusually high incidence of accelerated neuropathy we speculate that other unidentified factor(s) could be underlying its pathogenesis.
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Affiliation(s)
| | - Subramani Murugan
- Department of Medicine, Government KAPV Medical College, Trichy, India
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26
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Bhasin AA, MacRae JM, Manns B, Leung KCW, Molnar AO, Busse JW, Collister D, Brimble KS, Rabbat CG, Tyrwhitt J, Mazzetti A, Walsh M. The Association Between Intradialytic Symptom Clusters and Recovery Time in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis. Can J Kidney Health Dis 2024; 11:20543581241237322. [PMID: 38532937 PMCID: PMC10964465 DOI: 10.1177/20543581241237322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
Background Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain. Objectives To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL. Design/setting We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada. Participants Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance. Methods Participants self-reported the presence (1 = none to 5 = very much) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item-Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0, >0 to 2, >2 to 6, or >6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36. Results One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: -0.56, 25th to 75th percentile: -1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (-0.72 per unit difference in score, 95% CI: -1.29 to -0.15) and MCS scores (-0.82 per unit difference in score, 95% CI: -1.48 to -0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI -0.46 to 0.83; MCS -0.72, 95% CI: -1.50 to 0.06). Limitations This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings. Conclusions Intradialytic symptoms are correlated. The presence of select intradialytic symptoms may prolong the time it takes for a patient to recover from a dialysis treatment and impair HRQoL.
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Affiliation(s)
- Arrti A. Bhasin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Braden Manns
- Department of Medicine, University of Calgary, AB, Canada
| | | | - Amber O. Molnar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, ON, Canada
| | - Jason W. Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - David Collister
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - K Scott Brimble
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, ON, Canada
| | - Christian G. Rabbat
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, ON, Canada
| | | | | | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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27
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Kirchmayer U, Marino C, Feriozzi S, Massimetti C, Manzuoli M, Angelici L, Bargagli AM, Cascini S, Addis A, Davoli M, Agabiti N. Drug utilization in patients starting haemodialysis with a focus on cardiovascular and antidiabetic medications: an epidemiological study in the Lazio region (Italy), 2016-2020. BMC Nephrol 2024; 25:98. [PMID: 38493085 PMCID: PMC10943891 DOI: 10.1186/s12882-024-03539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis. METHODS Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age. RESULTS In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups. CONCLUSIONS Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.
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Grants
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
- Pharmacovigilance call 2012-2013-2014 (ETELDIA project) Agenzia Italiana del Farmaco, Ministero della Salute
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Affiliation(s)
- Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Claudia Marino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy.
| | | | | | - Micol Manzuoli
- UOC Nephrology and Dialysis, ASL Viterbo, Viterbo, Italy
| | - Laura Angelici
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Anna Maria Bargagli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Silvia Cascini
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
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Kingsmore D, Edgar B, Stevenson K, Greenlaw N, Aitken E, Jackson A, Thomson P. A practical review of barriers and challenges to a definitive randomised trial of grafts versus fistula. J Vasc Access 2024:11297298241234610. [PMID: 38436199 DOI: 10.1177/11297298241234610] [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: 03/05/2024] Open
Abstract
A definitive randomised controlled trial of arteriovenous fistula (AVF) versus arteriovenous grafts (AVG) has been advocated for more than a decade, but as yet, none has been completed. The aim of this article is to summarise the theoretical barriers, review the difficulties in trial design and practicalities that have thus far prevented this from occurring.
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Affiliation(s)
- David Kingsmore
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ben Edgar
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Karen Stevenson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nicola Greenlaw
- Glasgow Clinical Trials Unit, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Emma Aitken
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Jackson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Peter Thomson
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Yang J, Li YQ, Gong YL, Yan HL, Chen J, Liu LL, Wu J, Chu J. Benefit finding in individuals undergoing maintenance hemodialysis in Shanghai: a latent profile analysis. Front Psychol 2024; 15:1292175. [PMID: 38500646 PMCID: PMC10946449 DOI: 10.3389/fpsyg.2024.1292175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
Objective This multi-center cross-sectional study aimed to delineate latent profiles of benefit finding (BF) in individuals undergoing maintenance hemodialysis (MHD) in Shanghai and examine associations between these BF profiles, social support, and coping style. Methods A total of 384 individuals undergoing MHD (mean age = 57.90, SD = 13.36) were assessed using the Benefit Finding Scale, Simplified Coping Style Questionnaire, and Perceived Social Support Scale. Latent profile analysis (LPA) identified distinct BF categories. Analysis of variance (ANOVA) evaluated the correlation between BF groups and demographic variables, while the relationship between BF, social support, and coping style was tested through correlation and multiple regression analyses. Results LPA identified three BF groups: rich BF (54.17%), moderate BF (41.14%), and poor BF (4.69%). Regression analyses indicated that positive coping and social support are protective factors for BF. Additionally, older age and heightened understanding of MHD correlated with higher BF levels. Conclusion The findings highlighted the importance of recognizing different BF profiles in individuals on MHD and working toward promoting BF levels in the rich BF and moderate BF groups, while helping the poor BF group to identify and address their challenges. Medical professionals should consider interventions tailored to individual psychological profiles to improve mental health and quality of life outcomes in this population.
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Affiliation(s)
- Jie Yang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yong-qi Li
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yan-lin Gong
- School of Nursing, Naval Medical University, Shanghai, China
| | - Hong-li Yan
- School of Health Services Management, Southern Medical University, Guangzhou, China
| | - Jing Chen
- Department of Nephrology, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Ling-ling Liu
- Department of Nephrology, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Jing Wu
- School of Nursing, Naval Medical University, Shanghai, China
| | - Jing Chu
- School of Nursing, Naval Medical University, Shanghai, China
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30
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Tang QH, Yang H, Chen J, Lin QN, Qin Z, Hu M, Qin X. Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: A meta-analysis and systematic review. J Vasc Access 2024; 25:369-389. [PMID: 35708346 DOI: 10.1177/11297298221102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is challenging for a surgeon to determine the appropriate vascular access for hemodialysis patients whose cephalic vein is usually inaccessible. The purpose of the study is to compare the complications and patency rates between transposed arteriovenous fistulas (tAVF) and arteriovenous graft (AVG) for the hemodialysis patients. Studies were recruited from PubMed, Cochrane library, EMBASE, the web of science databases, and reviewing reference lists of related studies from the inception dates to September 2, 2021. Statistical analyses were conducted using the statistical tool Review Manager version5.3 (Cochrane Collaboration, London, UK). I2 > 50% was defined as a high degree of heterogeneity, and then a random-effects model was used. Otherwise, the fixed-effects model was used. Odds ratio with its 95% confidence interval (95% CI) was used. Thirty-three trials (26 retrospective studies, four randomized controlled trials, two prospective trials, and one controlled-comparative study) with 6430 enrolled participants were identified in our analysis. The results showed that tAVF was accompanied with lower thrombosis rate (103/1184 (8.69%) vs 257/1367 (18.80%); I2 = 45%; 95% CI, 0.34 (0.26, 0.45)) and infection rate (43/2031 (2.12%) vs 180/2147 (8.38%); I2 = 0%; 95% CI, 0.20 (0.14, 0.30)) than arteriovenous graft. The significantly better primary patency rates, secondary patency rates, and primary assisted patency rates during follow-up were found in tAVF. However, the failure rate and the prevalence of hematoma were significantly lower in AVG group. No evidence showed the rate of overall mortality, steal syndrome, and aneurysm reduced in tAVF. Our results showed that tAVF is a promising vascular access technique for hemodialysis patients whose cephalic vein is inaccessible. Our data showed that tAVF has less thrombosis, infection risk, and better patency rates when compared with AVG. However, more attentions need to be paid to transposed arteriovenous fistulas maturation and hematoma.
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Affiliation(s)
- Qian-Hui Tang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han Yang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing Chen
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiu-Ning Lin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhong Qin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ming Hu
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Qin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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31
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Bağriaçik E, Dikmen BT. Self-management training in patients with chronic kidney disease undergoing hemodialysis: A systematic review. Semin Dial 2024; 37:91-100. [PMID: 37353998 DOI: 10.1111/sdi.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/25/2023]
Abstract
The aim of this systematic review is to investigate the effectiveness of different self-management training programs applied to dialysis patients. During the literature review, the flow chart of preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) was utilized. The review was limited by the year. All studies in English were screened in the databases "Ulakbim National Database, Google Scholar, Scopus, PubMed, Science Direct, Web of Science, Medline, EBSCOhost, and Cochrane Library." Eleven studies, including nine randomized controlled and two quasi-experimental, were included in the review.
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Affiliation(s)
- Ezgi Bağriaçik
- Faculty of Nursing, Department of Internal Medicine, Near East University, Nicosia, Turkish Republic of Northern Cyprus
| | - Burcu Totur Dikmen
- Department of Surgery, Near East University Nursing Faculty, Nicosia, Turkish Republic of Northern Cyprus
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32
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Wülfrath HS, Schrumpf T, von Samson-Himmelstjerna FA, Voran J, Zhang Y, Esser G, Thomsen SY, Messtorff ML, Riebeling T, Kakavand N, Schmitt R, Schulte K, Kolbrink B. The Intersectoral Coordination Unit for the Sustainable Intensification of Peritoneal Dialysis in Schleswig-Holstein (SKIP-SH) cohort study. BMC Nephrol 2024; 25:75. [PMID: 38429741 PMCID: PMC10908112 DOI: 10.1186/s12882-024-03519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) remains underutilised in Germany, prompting the initiation of the Sustainable Intensification of Peritoneal Dialysis in Schleswig-Holstein (SKIP-SH) project. The SKIP-SH cohort study aims to demonstrate the presumed benefits of PD, including enhanced quality of life and reduced healthcare personnel requirements, and to generate data to strengthen the use of PD. METHODS The prospective SKIP-SH cohort study recruits patients with advanced chronic kidney disease (CKD) and their caregivers. Comprehensive data, including demographic information, medical history, clinical course, laboratory data, and quality-of-life assessments, are collected. Additionally, biomaterials will be obtained. Primary study objectives are documenting the clinical course and complications, time on therapy for new dialysis patients, reasons influencing treatment modality choices, circumstances at the initiation of dialysis, and quality of life for patients with CKD and their caregivers. The collected biomaterials will serve as a basis for further translational research. Secondary objectives include identifying factors impacting disease-related quality of life, clinical complications, and therapy dropout, estimating ecological footprints, and evaluating healthcare costs and labour time for initiating and sustaining PD treatment. DISCUSSION PD is notably underutilised in Germany. The current therapy approach for advanced CKD often lacks emphasis on patient-focused care and quality-of-life considerations. Furthermore, adequate explorative research programs to improve our knowledge of mechanisms leading to disease progression and therapy failure in PD patients are scarce. The overarching goal of the SKIP-SH cohort study is to address the notably low PD prevalence in Germany whilst advocating for a shift towards patient-focused care, quality-of-life considerations, and robust translational research. TRIAL REGISTRATION This study was registered with the German trial registry (Deutsches Register klinischer Studien) on November 7, 2023, under trial number DRKS00032983.
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Affiliation(s)
- Hauke S Wülfrath
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Thorben Schrumpf
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | | | - Jakob Voran
- Department of Medicine III, Cardiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Yao Zhang
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Grit Esser
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Sarah-Yasmin Thomsen
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Maja L Messtorff
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Theresa Riebeling
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Nassim Kakavand
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Roland Schmitt
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Benedikt Kolbrink
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany.
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33
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Corbett RW, Beckwith H, Lucisano G, Brown EA. Delivering Person-Centered Peritoneal Dialysis. Clin J Am Soc Nephrol 2024; 19:377-384. [PMID: 37611155 PMCID: PMC10937028 DOI: 10.2215/cjn.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
Peritoneal dialysis (PD) enables people to have a home-based therapy, permitting greater autonomy for individuals along with enhanced treatment satisfaction compared with in-center dialysis care. The burden of treatment on PD, however, remains considerable and underpins the need for person-centered care. This reflects the need to address the patient as a person with needs and preferences beyond just the medical perspective. Shared decision making is central to the recent International Society for Peritoneal Dialysis recommendations for prescribing PD, balancing the potential benefits of PD on patient well-being with the burden associated with treatment. This review considers the role of high-quality goal-directed prescribing, incremental dialysis, and remote patient monitoring in reducing the burden of dialysis, including an approach to implementing incremental PD. Although patient-related outcomes are important in assessing the response to treatment and, particularly life participation, the corollary of dialysis burden, there are no clear routes to the clinical implementation of patient-related outcome measures. Delivering person-centered care is dependent on treating people both as individuals and as equal partners in their care.
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Affiliation(s)
- Richard W. Corbett
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Hannah Beckwith
- MRC London Institute of Medical Sciences (LMS), Imperial College London, London, United Kingdom
| | - Gaetano Lucisano
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edwina A. Brown
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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34
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Ghimire A, Shah S, Okpechi IG, Ye F, Tungsanga S, Vachharajani T, Levin A, Johnson D, Ravani P, Tonelli M, Thompson S, Jha V, Luyckx V, Jindal K, Shah N, Caskey FJ, Kazancioglu R, Bello AK. Global variability of vascular and peritoneal access for chronic dialysis. Nephrology (Carlton) 2024; 29:135-142. [PMID: 38018697 DOI: 10.1111/nep.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
AIM Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. METHODS An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. RESULTS Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. CONCLUSION There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samveg Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Tushar Vachharajani
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekananda Jha
- George Institute of Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Valerie Luyckx
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kailash Jindal
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Rumeyza Kazancioglu
- School of Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Aminu K Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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Casino FG, Roblero MFS, González-Sanchidrian S, Dominguez SG, Ferris IL, Luyckx VA, Liakopoulos V, Mitra S, Lorenzo JD, Basile C. Prescribing the dialysis dose and treatment frequency in home haemodialysis. Nephrol Dial Transplant 2024; 39:445-452. [PMID: 37757455 PMCID: PMC10939408 DOI: 10.1093/ndt/gfad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV. METHODS Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week. RESULTS The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to -0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions. CONCLUSIONS The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD.
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Affiliation(s)
| | | | | | | | | | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vassilios Liakopoulos
- Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals and University of Manchester, Manchester, UK
| | | | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Wu CC, Islam MM, Poly TN, Weng YC. Artificial Intelligence in Kidney Disease: A Comprehensive Study and Directions for Future Research. Diagnostics (Basel) 2024; 14:397. [PMID: 38396436 PMCID: PMC10887584 DOI: 10.3390/diagnostics14040397] [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: 12/04/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Artificial intelligence (AI) has emerged as a promising tool in the field of healthcare, with an increasing number of research articles evaluating its applications in the domain of kidney disease. To comprehend the evolving landscape of AI research in kidney disease, a bibliometric analysis is essential. The purposes of this study are to systematically analyze and quantify the scientific output, research trends, and collaborative networks in the application of AI to kidney disease. This study collected AI-related articles published between 2012 and 20 November 2023 from the Web of Science. Descriptive analyses of research trends in the application of AI in kidney disease were used to determine the growth rate of publications by authors, journals, institutions, and countries. Visualization network maps of country collaborations and author-provided keyword co-occurrences were generated to show the hotspots and research trends in AI research on kidney disease. The initial search yielded 673 articles, of which 631 were included in the analyses. Our findings reveal a noteworthy exponential growth trend in the annual publications of AI applications in kidney disease. Nephrology Dialysis Transplantation emerged as the leading publisher, accounting for 4.12% (26 out of 631 papers), followed by the American Journal of Transplantation at 3.01% (19/631) and Scientific Reports at 2.69% (17/631). The primary contributors were predominantly from the United States (n = 164, 25.99%), followed by China (n = 156, 24.72%) and India (n = 62, 9.83%). In terms of institutions, Mayo Clinic led with 27 contributions (4.27%), while Harvard University (n = 19, 3.01%) and Sun Yat-Sen University (n = 16, 2.53%) secured the second and third positions, respectively. This study summarized AI research trends in the field of kidney disease through statistical analysis and network visualization. The findings show that the field of AI in kidney disease is dynamic and rapidly progressing and provides valuable information for recognizing emerging patterns, technological shifts, and interdisciplinary collaborations that contribute to the advancement of knowledge in this critical domain.
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Affiliation(s)
- Chieh-Chen Wu
- Department of Healthcare Information and Management, School of Health and Medical Engineering, Ming Chuan University, Taipei 111, Taiwan;
| | - Md. Mohaimenul Islam
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA;
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan;
| | - Yung-Ching Weng
- Department of Healthcare Information and Management, School of Health and Medical Engineering, Ming Chuan University, Taipei 111, Taiwan;
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Shi Y, Pu S, Peng H, Luo Y. Development and validation of the patient-reported outcome scale for chronic kidney disease. Int Urol Nephrol 2024; 56:653-665. [PMID: 37452989 PMCID: PMC10808283 DOI: 10.1007/s11255-023-03702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The patient-reported outcomes (PROs) measuring patient's experience and perception of disease are important components of approach to care. However, no tools are available to assess the PROs of chronic kidney disease (CKD). This study aims to develop and verify a PROs scale to evaluate clinical outcomes in CKD patients. METHODS The theoretical structure model and original item pool were formed through a literature review, patient interviews and references to relevant scales. The Delphi method, classical test theory methods and item response theory method were used to select items and adjust dimensions to form the final scale. Altogether 360 CKD patients were recruited through convenience sampling. CKD-PROs could be evaluated from four aspects, namely reliability, content validity, construct validity, responsibility, and feasibility. RESULTS The CKD-PROs scale covers 4 domains, including the physiological, psychological, social, and therapeutic domain, and 12 dimensions, 54 items. The Cronbach's α is 0.939, the split reliability coefficient is 0.945, and the correlation of the scores each item and domain's coefficients range from 0.413 to 0.669. The results of structure validity, content validity and reactivity showed that the multidimensional measurement of the scale met professional expectations. The recovery rate and effective rate of the scale were over 99%. CONCLUSION The CKD-PROs scale has great reliability, validity, reactivity, acceptability and is capable of being used as one of the evaluation tools for the clinical outcomes of CKD patients.
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Affiliation(s)
- Yu Shi
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Shi Pu
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Hongmei Peng
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Yu Luo
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China.
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Bnaya A, Schwartz Y, Wolfovitz Barchad O, Atrash J, Bar-Meir M, Shavit L, Ben-Chetrit E. Clinical presentation and outcome of hemodialysis tunneled catheter-related bloodstream infection in older persons. Eur Geriatr Med 2024; 15:235-242. [PMID: 37713092 DOI: 10.1007/s41999-023-00861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The use of a tunneled catheter as the primary vascular access among old hemodialysis patients is frequent. Catheter-related bloodstream infection (CRBSI) is a common complication, associated with increased mortality. Data regarding the clinical presentation and outcomes of CRBSI among old hemodialysis patients is limited. METHODS All chronic hemodialysis patients hospitalized between 2010 and 2022 with CRBSI were included. Patients were classified into two groups: old adults (≥ 75) and younger patients. Clinical, microbiological, and outcome data were collected and analyzed. RESULTS One hundred and fifty-four patients with CRBSI were identified. Fifty-seven were aged ≥ 75 years. Mean age in the older and younger groups was 81.2 ± 5 and 59.7 ± 12.7, respectively. Male gender was predominant (64%). Charlson comorbidity score and Pitt bacteremia score were comparable among both groups. Norton score < 14 was more common among old persons (n = 24, 67% versus n = 21, 31%, p < 0.001), as well as nursing-home residence. Gram-negative pathogens and Staphylococcus aureus were common in both groups. The frequency of inappropriate empirical antimicrobial treatment was higher among older persons. Overall, in-hospital and 90-day mortality was high (age ≥ 75, 36.8%, age < 75, 24.7%, p = 0.14). Age was not significantly associated with mortality after adjustment for low Norton score, residence, and inappropriate antimicrobial therapy as well as resistance patterns of bloodstream isolates [OR = 1.2 (95% CI 0.4-3.3), p = 0.76]. CONCLUSIONS Clinical characteristics and outcomes of CRBSI were comparable among old and young hemodialysis patients. However, the high mortality rate in this cohort suggests that the use of tunneled catheters as a permanent vascular access should be discouraged in both patient groups.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Yuval Schwartz
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Orit Wolfovitz Barchad
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Jawad Atrash
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Maskit Bar-Meir
- Pediatric Infectious Diseases, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel.
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Ashrafi SA, Alam RB, Kraay A, Ogunjesa BA, Schwingel A. Disparities in healthcare access experienced by Hispanic chronic kidney disease patients: a cross-sectional analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:18. [PMID: 38297384 PMCID: PMC10832131 DOI: 10.1186/s41043-024-00508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a public health concern, and the disease disproportionately affects Hispanics. Improved healthcare access for Hispanic CKD patients can reduce the disease burden. This study assesses the healthcare access disparities experienced by Hispanic CKD patients compared to Whites. METHODS We analyzed three National Health and Nutrition Examination Survey (NHANES) datasets for 2013-2014, 2015-2016, and 2017-2018. The primary predictor variable was race, and the outcome variable was three domains of healthcare access: insurance status, having any routine place for healthcare, and having any health visits in the past year. Chi-square tests and unadjusted and adjusted multivariate logistic regressions were conducted. The models were adjusted for age, education, income, and CKD stages and were weighted to account for the sampling strategy. RESULTS The sample size was 1864 CKD patients from three two-year cycles of NHANES datasets (2013-2014, 2015-2016, and 2017-2018). The final adjusted model found that Hispanic CKD patients were more likely to be uninsured (OR: 2.52, CI 1.66-3.83) and have no routine place for healthcare (OR: 1.68, CI 1.03-2.75) than White CKD patients, but did not have differences in healthcare visits in the past year. CONCLUSIONS Hispanic CKD patients have limited healthcare access compared to White populations showing existing care access disparities experienced by them. Improved programs and policies are required to enhance kidney health among Hispanics and promote equity in CKD.
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Affiliation(s)
- Sadia Anjum Ashrafi
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Rifat Binte Alam
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Alicia Kraay
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Babatope Ayokunle Ogunjesa
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Andiara Schwingel
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA.
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Armstrong M, Wityk Martin TL, Zimmermann GL, Drall K, Pannu NI. Personalising haemodialysis treatment with incremental dialysis for incident patients with end-stage kidney disease: an implementation study protocol. BMJ Open 2024; 14:e075195. [PMID: 38286687 PMCID: PMC10826580 DOI: 10.1136/bmjopen-2023-075195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Incremental dialysis is a personalised dialysis prescription based on residual kidney function that allows for the initial use of shorter duration, less frequent and less intense dialysis. It has been associated with enhanced quality of life and decreased healthcare costs when compared with conventional dialysis. While nephrologists report prescribing incremental dialysis, few dialysis programmes offer a systematic approach in offering and evaluating its use. To move evidence into practice, and in order to improve the safety and quality of providing incremental dialysis care, we have designed an implementation study. This study aims to evaluate the systematic assessment of patients starting facility-based haemodialysis for eligibility for incremental dialysis, and the prescription and monitoring of incremental dialysis treatment. METHODS AND ANALYSIS A hybrid effectiveness and implementation study design is being used to evaluate the implementation of the programme at dialysis sites in Alberta, Canada. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to capture individual-level and organisational-level impact of the project. Clinical outcomes related to kidney function will be monitored on an ongoing basis, and patient-reported outcomes and experience measures will be collected at baseline and then quarterly throughout the first year of dialysis. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of the University of Alberta. The study is funded by the Strategic Clinical Networks of Alberta Health Services. The study will help answer important questions on the effectiveness of incremental dialysis, and inform the acceptability, adoption, feasibility, reach and sustainability of incremental dialysis within provision of haemodialysis care.
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Affiliation(s)
- Marni Armstrong
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsea Drall
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Neesh I Pannu
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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Liu Y, Zhou Y, Li X, Zhang J. Influences of trans-theoretical model-based diet nursing intervention on sarcopenia and quality of life in maintenance hemodialysis patients. NUTR HOSP 2024. [PMID: 38328951 DOI: 10.20960/nh.04844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE to explore the influences of a trans-theoretical model-based diet nursing intervention on sarcopenia and quality of life in maintenance hemodialysis patients. METHODS the clinical data of 243 patients with maintenance hemodialysis (MHD) admitted to our hospital from January 2019 to August 2020 were retrospectively analyzed. A 1:1 orientation score matching (PSM) method was adopted, and patients with different intervention methods were matched based on gender, age, education time, dialysis age, body mass index, underlying diseases, annual income, and whether they were malnourished. Finally, 82 cases were included in the control group (routine nursing and dietary guidance) and 80 cases in the intrevention group (dietary nursing intervention based on the trans-theoretical model), respectively. RESULTS After PSM, 82 cases in the control group and 80 cases in the intrevention group were included in the study. After the intervention, the incidence of sarcopenia, the extracellular water rate (ECF/TBF) value, and the malnutrition rate of the intrevention group were lower than those of the control group (p < 0.05); the scores of self-care, facing difficulties, potassium intake management, salt intake management, fluid restriction management, the levels of serum albumin, prealbumin and transferrin were all higher than those of the control group (p < 0.05); the SF-36 Concise Health Scale score of the intrevention group was higher than that of the control group (p < 0.05). The 1-year survival rate in the intrevention group (95.00 %) was higher than that in the control group (85.37 %) (p < 0.05). CONCLUSION a TTM-based diet nursing intervention can help improve the dietary management behavior of MHD patients, prevent malnutrition, reduce the incidence of sarcopenia, and improve their quality of life and survival rate.
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Affiliation(s)
- Yanwen Liu
- Phase 1 Drug Clinical Trial Ward. The Second Affiliated Hospital. Hengyang Medical School
| | - Yan Zhou
- Department of Nephropathy and Rheumatism. The Second Affiliated Hospital. Hengyang Medical School. University of South China
| | - Xiaoping Li
- Department of Nephropathy and Rheumatism. The Second Affiliated Hospital. Hengyang Medical School. University of South China
| | - Jun Zhang
- Department of Nephropathy and Rheumatism. The Second Affiliated Hospital. Hengyang Medical School. University of South China
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Hemmige V, Deshpande P, Norris KC, Shen JI, Erickson KF, Johansen KL, Golestaneh L. Geographic Dialysis Facility Density and Early Dialysis Initiation. JAMA Netw Open 2024; 7:e2350009. [PMID: 38170525 PMCID: PMC10765261 DOI: 10.1001/jamanetworkopen.2023.50009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/29/2023] [Indexed: 01/05/2024] Open
Abstract
Importance The decision of when to start maintenance hemodialysis may be affected by health system-level support for high-intensity care as manifested by area dialysis facility density. Yet an association between early hemodialysis initiation and higher area density of dialysis facilities has not been shown. Objective To examine whether there is an association between area dialysis facility density and earlier dialysis initiation. Design, Setting, and Participants Cross-sectional analysis was conducted of publicly reported claims and geographic-based population data collected in the Medical Evidence files of the US Renal Data System (USRDS), a comprehensive registry of all patients initiating hemodialysis in the US, from calendar years 2011 through 2019. Data were linked to the American Community Survey, using residential zip codes, and then to health service area (HSA) primary care and hospitalization benchmarks, using the Dartmouth Atlas crosswalk. Data were analyzed from November 1, 2021, to August 31, 2023. Exposure Dialysis facility density at the level of HSA (number of dialysis facilities per 100 000 HSA residents) split into 5 categories. Main Outcomes and Measures The odds of hemodialysis initiation at an estimated glomerular filtration rate (eGFR) greater than 10 mL/min/1.73 m2 vs less than or equal to 10 mL/min/1.73 m2. Results Hemodialysis was initiated in a total of 844 466 individuals at 3397 HSAs at a mean (SD) eGFR of 8.9 (3.8) mL/min/1.73 m2. Their mean (SD) age was 63.5 (14.7) years, and 484 346 participants (57.4%) were men. In the HSA category with the highest facility density, individuals were younger (63.3 vs 65.2 years in least-dense HSAs), poorer (mean percent of households living in poverty, 10.4% vs 8.4%), and more commonly had a higher percentage of Black individuals (40.6% vs 11.3%). More individuals in the dialysis-dense HSAs than least-dense HSAs had diabetes (60.1% vs 58.5%) and fewer had access to predialysis nephrology care (60.8% vs 64.1%); the rates of heart failure and immobility varied, but not in a consistent pattern, by HSA dialysis density. The mean (SD) facility density was 4.1 (1.89) centers per 100 000 population in the most dialysis-dense HSAs. Compared with patients in HSAs with a mean of 1.0 per 100 000 population, the odds of hemodialysis initiation at eGFR greater than 10 mL/min/1.73 m2 were 1.07 (95% CI, 1.03-1.11) for patients in the densest HSAs, and compared with HSAs with 0 facilities, the odds of early hemodialysis initiation were 1.06 (95% CI, 1.02-1.10) for patients in the densest HSAs. Conclusions and Relevance In this cross-sectional study of USRDS- and HSA-level data, HSA dialysis density was associated with early hemodialysis initiation.
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Affiliation(s)
- Vagish Hemmige
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Priya Deshpande
- Division of Nephrology, Mt Sinai School of Medicine, New York, New York
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California
| | - Jenny I. Shen
- Division of Nephrology, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, California
| | | | | | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Wetmore JB, Johansen KL, Gilbertson DT, Roetker NS. Symptom Trajectories in the Electronic Health Record during the Transition to Maintenance Dialysis. Clin J Am Soc Nephrol 2024; 19:101-107. [PMID: 37962893 PMCID: PMC10843208 DOI: 10.2215/cjn.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
How symptoms recorded in the electronic health record change during the transition to dialysis has not been fully explored. We used the Optum deidentified Integrated Claims-Clinical dataset to identify individuals with CKD stages 4 or 5 who transitioned to dialysis. We searched structured data elements from clinical notes, identified by natural language processing, for symptoms recorded across weekly intervals in the 6 months before and after dialysis initiation and estimated changes in the odds of a symptom being recorded with an interrupted time series analysis using segmented logistic regression. The cohort comprised 728 individuals (aged 68±13 years, 44% women, 56% White, 30% Black). Before dialysis initiation, 83% were recorded as having pain, 68% fatigue/weakness, 66% shortness of breath, 61% nausea/vomiting, and 37% difficulty concentrating. Before dialysis initiation, odds of pain being recorded increased (slope: odds ratio [OR] 1.02 per week, 95% confidence interval [CI], 1.01 to 1.03); initiation was associated with a decrease (intercept change: OR 0.70, 95% CI, 0.59 to 0.82). After initiation, odds of pain were unchanged (postdialysis slope: OR 1.00 per week, 95% CI, 0.99 to 1.01), although this represented an improved trajectory relative to the predialysis period (change in slope: OR 0.98 per week, 95% CI, 0.96 to 0.99). For fatigue/weakness, odds increased before initiation (OR 1.03 per week, 95% CI, 1.02 to 1.04) but decreased on initiation (OR 0.62, 95% CI, 0.51 to 0.75) and thereafter (OR 0.98 per week, 95% CI, 0.97 to 0.99), representing a reduction in slope (OR 0.95 per week, 95% CI, 0.94 to 0.97). Patterns for shortness of breath, nausea/vomiting, and difficulty concentrating were similar to those of pain. Thus, the odds of five key symptoms being recorded in the electronic health record increased over time in the 6 months before dialysis initiation, decreased immediately on initiation, and, generally, remained unchanged in the 6 months thereafter.
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Affiliation(s)
- James B. Wetmore
- Division of Nephrology, Hennepin Healthcare and Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Kirsten L. Johansen
- Division of Nephrology, Hennepin Healthcare and Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - David T. Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Nicholas S. Roetker
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Cheng XBJ, Chan CT. Systems Innovations to Increase Home Dialysis Utilization. Clin J Am Soc Nephrol 2024; 19:108-114. [PMID: 37651291 PMCID: PMC10843223 DOI: 10.2215/cjn.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Globally, there is an interest to increase home dialysis utilization. The most recent United States Renal Data System (USRDS) data report that 13.3% of incident dialysis patients in the United States are started on home dialysis, while most patients continue to initiate KRT with in-center hemodialysis. To effect meaningful change, a multifaceted innovative approach will be needed to substantially increase the use of home dialysis. Patient and provider education is the first step to enhance home dialysis knowledge awareness. Ideally, one should maximize the number of patients with CKD stage 5 transitioning to home therapies. If this is not possible, infrastructures including transitional dialysis units and community dialysis houses may help patients increase self-care efficacy and eventually transition care to home. From a policy perspective, adopting a home dialysis preference mandate and providing financial support to recuperate increased costs for patients and providers have led to higher uptake in home dialysis. Finally, respite care and planned home-to-home transitions can reduce the incidence of transitioning to in-center hemodialysis. We speculate that an ecosystem of complementary system innovations is needed to cause a sufficient change in patient and provider behavior, which will ultimately modify overall home dialysis utilization.
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Affiliation(s)
- Xin Bo Justin Cheng
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Desbiens LC, Tennankore KK, Goupil R, Perl J, Trinh E, Chan CT, Nadeau-Fredette AC. Outcomes of Integrated Home Dialysis Care: Results From the Canadian Organ Replacement Register. Am J Kidney Dis 2024; 83:47-57.e1. [PMID: 37657633 DOI: 10.1053/j.ajkd.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 09/03/2023]
Abstract
RATIONALE & OBJECTIVE The integrated home dialysis model proposes the initiation of kidney replacement therapy (KRT) with peritoneal dialysis (PD) and a timely transition to home hemodialysis (HHD) after PD ends. We compared the outcomes of patients transitioning from PD to HHD with those initiating KRT with HHD. STUDY DESIGN Observational analysis of the Canadian Organ Replacement Register (CORR). SETTINGS & PARTICIPANTS All patients who initiated PD or HHD within the first 90 days of KRT between 2005 and 2018. EXPOSURE Patients transitioning from PD to HHD (PD+HHD group) versus patients initiating KRT with HHD (HHD group). OUTCOME (1) A composite of all-cause mortality and modality transfer (to in-center hemodialysis or PD for 90 days) and (2) all hospitalizations (considered as recurrent events). ANALYTICAL APPROACH A propensity score analysis for which PD+HHD patients were matched 1:1 to (1) incident HHD patients ("incident-match" analysis) or (2) HHD patients with a KRT vintage at least equivalent to the vintage of PD+HHD patients at the transition time ("vintage-matched" analysis). Cause-specific hazards models (composite outcome) and shared frailty models (hospitalization) were used to compare groups. RESULTS Among 63,327 individuals in the CORR, 163 PD+HHD patients (median of 1.9 years in PD) and 711 HHD patients were identified. In the incident-match analysis, compared to the HHD patients, the PD+HHD group had a similar risk of the composite outcome (HR, 0.88 [95% CI, 0.58-1.32]) and hospitalizations (HR, 1.04 [95% CI, 0.76-1.41]). In the vintage-match analysis, PD+HHD patients had a lower hazard for the composite outcome (HR, 0.61 [95% CI, 0.40-0.94]) but a similar hospitalization risk (HR, 0.85 [95% CI, 0.59-1.24]). LIMITATIONS Risk of survivor bias in the PD+HHD cohort and residual confounding. CONCLUSIONS Controlling for KRT vintage, the patients transitioning from PD to HHD had better clinical outcomes than the incident HHD patients. These data support the use of integrated home dialysis for patients initiating home-based KRT. PLAIN-LANGUAGE SUMMARY The integrated home dialysis model proposes the initiation of dialysis with peritoneal dialysis (PD) and subsequent transition to home hemodialysis (HHD) once PD is no longer feasible. It allows patients to benefit from initial lifestyle advantages of PD and to continue home-based treatments after its termination. However, some patients may prefer to initiate dialysis with HHD from the outset. In this study, we compared the long-term clinical outcomes of both approaches using a large Canadian dialysis register. We found that both options led to a similar risk of hospitalization. In contrast, the PD-to-HHD model led to improved survival when controlling for the duration of kidney failure.
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Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Quebec, Montreal; Hôpital Maisonneuve-Rosemont, Quebec, Montreal
| | | | - Rémi Goupil
- Department of Medicine, Université de Montréal, Quebec, Montreal; Hôpital du Sacré-Coeur de Montréal, Quebec, Montreal
| | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Emilie Trinh
- McGill University Health Center, Quebec, Montreal
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Quebec, Montreal; Hôpital Maisonneuve-Rosemont, Quebec, Montreal.
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Dember LM, Hsu JY, Bernardo L, Cavanaugh KL, Charytan DM, Crowley ST, Cukor D, Doorenbos AZ, Edwards DA, Esserman D, Fischer MJ, Jhamb M, Joffe S, Johansen KL, Kalim S, Keefe FJ, Kimmel PL, Krebs EE, Kuzla N, Mehrotra R, Mishra P, Pellegrino B, Steel JL, Unruh ML, White DM, Yabes JG, Becker WC. The design and baseline characteristics for the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis. Contemp Clin Trials 2024; 136:107409. [PMID: 38086444 PMCID: PMC10922728 DOI: 10.1016/j.cct.2023.107409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024]
Abstract
The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial) is a multicenter randomized trial addressing chronic pain among patients receiving maintenance hemodialysis for end-stage kidney disease. The trial uses a sequential, multiple assignment design with a randomized component for all participants (Phase 1) and a non-randomized component for a subset of participants (Phase 2). During Phase 1, participants are randomized to Pain Coping Skills Training (PCST), an intervention designed to increase self-efficacy for managing pain, or Usual Care. PCST consists of weekly, live, coach-led cognitive behavioral therapy sessions delivered by video- or tele-conferencing for 12 weeks followed by daily interactive voice response sessions delivered by telephone for an additional 12 weeks. At 24 weeks (Phase 2), participants in both the PCST and Usual Care groups taking prescription opioid medications at an average dose of ≥20 morphine milligram equivalents per day are offered buprenorphine, a partial opioid agonist with a more favorable safety profile than full-agonist opioids. All participants are followed for 36 weeks. The primary outcome is pain interference ascertained, for the primary analysis, at 12 weeks. Secondary outcomes include additional patient-reported measures and clinical outcomes including falls, hospitalizations, and death. Exploratory outcomes include acceptability, tolerability, and efficacy of buprenorphine. The enrollment target of 640 participants was met 27 months after trial initiation. The findings of the trial will inform the management of chronic pain, a common and challenging issue for patients treated with maintenance hemodialysis. NCT04571619.
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Affiliation(s)
- Laura M Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Leah Bernardo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Kerri L Cavanaugh
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - David M Charytan
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, and NYU Langone Health, New York, NY, United States of America
| | - Susan T Crowley
- Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Kidney Medicine Program, Medical Services, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Daniel Cukor
- Behavioral Health, The Rogosin Institute, New York, NY, United States of America
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States of America
| | - David A Edwards
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Michael J Fischer
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States of America; Medical Service, Jesse Brown VA Medical Center, Chicago, IL, United States of America; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, United States of America
| | - Manisha Jhamb
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Kirsten L Johansen
- Nephrology Division, Hennepin Healthcare, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Sahir Kalim
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Francis J Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Erin E Krebs
- General Internal Medicine, Minneapolis VA Health Care System, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Natalie Kuzla
- Clinical Research Computing Unit, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Puneet Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Bethany Pellegrino
- Division of Nephrology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Jennifer L Steel
- Division of Hepatobiliary Surgery, Department of Surgery, Psychiatry, and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Mark L Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States of America; Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - David M White
- American Association of Kidney Patients, Tampa, FL, United States of America
| | - Jonathan G Yabes
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - William C Becker
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Pain Research, Informatics, Multi-morbidities & Education Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States of America
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47
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Zhu L, Li XL, Shi R, Wang DG. Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis. Ren Fail 2023; 45:2201361. [PMID: 37191187 DOI: 10.1080/0886022x.2023.2201361] [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: 05/17/2023] Open
Abstract
Background: The burden of physical and emotional symptoms caused by somatic illness is present in most dialysis patients. However, it's unclear how symptom burden varies among patients with different dialysis vintages. We sought to examine differences in the prevalence and severity of unpleasant symptoms in hemodialysis patients with diverse dialysis vintage cohorts.Methods: This cross-sectional study included patients on maintenance hemodialysis at the Second Hospital of Anhui Medical University. We used the Dialysis Symptom Index (DSI) to determine the associated unpleasant symptoms, which is a validated survey to assess symptom burden/severity (higher scores indicate more severe symptoms), over June 2022 - September 2022.Results: We studied 146 patients: 35 (24%) had a dialysis vintage of ≤12 months (group 1) and 111 (76%) had a dialysis vintage of >12 months (group 2). Concerning Group 1 patients, the prevalence and severity of unpleasant symptoms were significantly higher in Group 2, the most common individual symptoms included feeling tired or lack of energy and trouble falling asleep (i.e., 75-85% of patients in each group), with dialysis vintage being an independent influencing factor (adjusted OR, 0.19; 95% CI, 0.16 to 0.23). Lower hemoglobin levels, iron stores, and dialysis adequacy levels are correlated with longer dialysis vintage.Conclusion: We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse dialysis vintages hemodialysis cohort. Further studies are needed to accurately and routinely define the symptom burden of chronic patients with chronic kidney disease (CKD).
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Affiliation(s)
- Li Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Xun-Liang Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Rui Shi
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - De-Guang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
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48
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Watnick S, Blake PG, Mehrotra R, Mendu M, Roberts G, Tummalapalli SL, Weiner DE, Butler CR. System-Level Strategies to Improve Home Dialysis: Policy Levers and Quality Initiatives. Clin J Am Soc Nephrol 2023; 18:1616-1625. [PMID: 37678234 PMCID: PMC10723911 DOI: 10.2215/cjn.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
Advocacy and policy change are powerful levers to improve quality of care and better support patients on home dialysis. While the kidney community increasingly recognizes the value of home dialysis as an option for patients who prioritize independence and flexibility, only a minority of patients dialyze at home in the United States. Complex system-level factors have restricted further growth in home dialysis modalities, including limited infrastructure, insufficient staff for patient education and training, patient-specific barriers, and suboptimal physician expertise. In this article, we outline trends in home dialysis use, review our evolving understanding of what constitutes high-quality care for the home dialysis population (as well as how this can be measured), and discuss policy and advocacy efforts that continue to shape the care of US patients and compare them with experiences in other countries. We conclude by discussing future directions for quality and advocacy efforts.
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Affiliation(s)
- Suzanne Watnick
- Northwest Kidney Centers, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington
| | - Peter G. Blake
- Division of Nephrology, Western University, London, Ontario, Canada
- Ontario Renal Network, Toronto, Ontario, Canada
| | - Rajnish Mehrotra
- Department of Medicine, University of Washington, Seattle, Washington
| | - Mallika Mendu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Glenda Roberts
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sri Lekha Tummalapalli
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Daniel E. Weiner
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Catherine R. Butler
- Department of Medicine, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington
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49
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Josephson MA, Becker Y, Budde K, Kasiske BL, Kiberd BA, Loupy A, Małyszko J, Mannon RB, Tönshoff B, Cheung M, Jadoul M, Winkelmayer WC, Zeier M. Challenges in the management of the kidney allograft: from decline to failure: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023; 104:1076-1091. [PMID: 37236423 DOI: 10.1016/j.kint.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
In March 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a virtual Controversies Conference to address the important but rarely examined phase during which the kidney transplant is failing or has failed. In addition to discussing the definition of a failing allograft, 4 broad areas were considered in the context of a declining functioning graft: prognosis and kidney failure trajectory; immunosuppression strategies; management of medical and psychological complications, and patient factors; and choice of kidney replacement therapy or supportive care following graft loss. Identifying and paying special attention to individuals with failing allografts was felt to be important in order to prepare patients psychologically, manage immunosuppression, address complications, prepare for dialysis and/or retransplantation, and transition to supportive care. Accurate prognostication tools, although not yet widely available, were embraced as necessary to define allograft survival trajectories and the likelihood of allograft failure. The decision of whether to withdraw or continue immunosuppression after allograft failure was deemed to be based most appropriately on risk-benefit analysis and likelihood of retransplantation within a few months. Psychological preparation and support was identified as a critical factor in patient adjustment to graft failure, as was early communication. Several models of care were noted that enabled a medically supportive transition back to dialysis or retransplantation. Emphasis was placed on the importance of dialysis-access readiness before initiation of dialysis, in order to avoid use of central venous catheters. The centrality of the patient to all management decisions and discussions was deemed to be paramount. Patient "activation," which can be defined as engaged agency, was seen as the most effective way to achieve success. Unresolved controversies, gaps in knowledge, and areas for research were also stressed in the conference deliberations.
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Affiliation(s)
- Michelle A Josephson
- Section of Nephrology, Department of Medicine, and Transplant Institute, University of Chicago, Chicago, Illinois, USA.
| | - Yolanda Becker
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bertram L Kasiske
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bryce A Kiberd
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexandre Loupy
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, F-75015 Paris, France; Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Roslyn B Mannon
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Martin Zeier
- Division of Nephrology, University of Heidelberg, Heidelberg, Germany.
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50
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Alhasan KA, Yepes-Nuñez JJ, Askandarani S, Amer YS, Al-Jelaify M, Almatham KI, Al-Ghonaim M, Al Dalbhi S, Kari JA, Mitwalli A, Memish ZA, Valson JS, Alvira X, Bilimoria K, Chawla R, Feit S, Bickett S, Brunnhuber K. Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian Context Using the Grading of Recommendations Assessment, Development, and Evaluation-ADOLOPMENT Methodology. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:S177-S218. [PMID: 38995286 DOI: 10.4103/sjkdt.sjkdt_68_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030's health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.
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Affiliation(s)
- Khalid A Alhasan
- Department of Pediatrics, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Saudi Society of Nephrology and Transplantation, Riyadh, Saudi Arabia
- Kidney and Pancreas Health Center, Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Juan José Yepes-Nuñez
- Universidad de los Andes, School of Medicine, Bogotá, Colombia
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Sumayah Askandarani
- Multi-Organ Transplant Center King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Yasser S Amer
- Department of Pediatrics, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Corporate Quality Management, Clinical Practice Guidelines and Quality Research Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Adaptation Working Group, Guidelines International Network, Perth, Scotland, UK
| | - Muneera Al-Jelaify
- Pharmacy Services Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid I Almatham
- Nephrology Division, King Fahad Medical City, College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Mohammed Al-Ghonaim
- Department of Medicine, Nephrology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sultan Al Dalbhi
- Department of Nephrology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Mitwalli
- Department of Medicine, Nephrology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Nephrology Department, Dallah Hospital, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Centre, College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | | | - Ximena Alvira
- Clinical Solutions, Elsevier Limited, Barcelona, Spain
| | | | - Ruchi Chawla
- Clinical Solutions, RELX Group New Delhi Ltd. Gurgaon, New Delhi, India
| | - Sheila Feit
- Clinical Solutions, Elsevier Limited. London, United Kingdom
| | - Skye Bickett
- Clinical Solutions, Elsevier Limited. London, United Kingdom
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