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van der Horst D, van Uden-Kraan C, Parent E, Bart J, Waverijn G, Verberk-Jonkers I, van den Dorpel M, Pieterse A, Bos W. Optimizing the use of patients’ individual outcome information – development and usability tests of a Chronic Kidney Disease dashboard. Int J Med Inform 2022; 166:104838. [DOI: 10.1016/j.ijmedinf.2022.104838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
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de Jong Y, van der Willik EM, Milders J, Meuleman Y, Morton RL, Dekker FW, van Diepen M. Person centred care provision and care planning in chronic kidney disease: which outcomes matter? A systematic review and thematic synthesis of qualitative studies : Care planning in CKD: which outcomes matter? BMC Nephrol 2021; 22:309. [PMID: 34517825 PMCID: PMC8438879 DOI: 10.1186/s12882-021-02489-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
RATIONALE & OBJECTIVE Explore priorities related to outcomes and barriers of adults with chronic kidney disease (CKD) regarding person centred care and care planning. STUDY DESIGN Systematic review of qualitative studies. SEARCH STRATEGY & SOURCES In July 2018 six bibliographic databases, and reference lists of included articles were searched for qualitative studies that included adults with CKD stages 1-5, not on dialysis or conservative management, without a previous kidney transplantation. ANALYTICAL APPROACH Three independent reviewers extracted and inductively coded data using thematic synthesis. Reporting quality was assessed using the COREQ and the review reported according to PRISMA and ENTREQ statements. RESULTS Forty-six studies involving 1493 participants were eligible. The period after diagnosis of CKD is characterized by feelings of uncertainty, social isolation, financial burden, resentment and fear of the unknown. Patients show interest in ways to return to normality and remain in control of their health in order to avoid further deterioration of kidney function. However, necessary information is often unavailable or incomprehensible. Although patients and healthcare professionals share the predominant interest of whether or not dialysis or transplantation is necessary, patients value many more outcomes that are often unrecognized by their healthcare professionals. We identified 4 themes with 6 subthemes that summarize these findings: 'pursuing normality and control' ('pursuing normality'; 'a search for knowledge'); 'prioritizing outcomes' ('reaching kidney failure'; 'experienced health'; 'social life'; 'work and economic productivity'); 'predicting the future'; and 'realising what matters'. Reporting quality was moderate for most included studies. LIMITATIONS Exclusion of non-English articles. CONCLUSIONS The realisation that patients' priorities do not match those of the healthcare professionals, in combination with the prognostic ambiguity, confirms fatalistic perceptions of not being in control when living with CKD. These insights may contribute to greater understanding of patients' perspectives and a more person-centred approach in healthcare prioritization and care planning within CKD care.
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Affiliation(s)
- Ype de Jong
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
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Missing In-Center Hemodialysis Sessions among Patients with End Stage Renal Disease in Banda Aceh, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179215. [PMID: 34501804 PMCID: PMC8431045 DOI: 10.3390/ijerph18179215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 01/13/2023]
Abstract
Indonesian universal health coverage was implemented in 2013 and hemodialysis services became universally accessible, yet few studies have examined patient adherence to hemodialysis schedules. We examined the rates of missed in-center hemodialysis sessions in Banda Aceh and the factors associated with non-attendance. This cross-sectional questionnaire survey included 193 patients receiving in-center hemodialysis. Approximately 28% of the patients missed ≥ 1 hemodialysis session in the month prior to the questionnaire’s administration. About 65% reported attending religious activities as the reason for missing hemodialysis. The level of health literacy was generally low with a mean score of 14.38 out of 26 (55.3%). Multivariate logistic regression analyses showed that patients with educational levels higher than elementary school were less likely to miss hemodialysis sessions. Participants who performed more self-care behaviors had lower odds of missing hemodialysis sessions. Every unit increase in the health literacy score was associated with increased odds of missing hemodialysis sessions. Emphasizing the importance of attending hemodialysis sessions and modifying hemodialysis schedules based on patients’ needs is essential. Patients who miss hemodialysis sessions should be reminded of all self-care behaviors. Health literacy among hemodialysis patients should be improved, with emphasis on patient safety, advanced knowledge, and critical health literacy.
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Wembenyui C, Douglas C, Bonner A. Validation of the Australian version of the Chronic Kidney Disease Self-Management instrument. Int J Nurs Pract 2020; 27:e12857. [PMID: 32614488 DOI: 10.1111/ijn.12857] [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: 05/13/2019] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study is to evaluate the validity and reliability of the modified Chronic Kidney Disease Self-Management instrument in an English-speaking population. BACKGROUND There is growing evidence that self-management behaviours can improve outcomes for people with chronic kidney disease. However, there are few suitable instruments available. DESIGN The study was cross sectional, with a test-retest protocol. METHOD Adults with chronic kidney disease attending a primary health care between June and December 2015 completed the Chronic Kidney Disease Self-Management instrument. Construct validity was determined using exploratory factor analysis, internal consistency and test-retest reliability using Cronbach's α and intraclass correlation. For convergent validity, the relationships between knowledge, self-efficacy and self-management were investigated. RESULTS The Australian version of the Chronic Kidney Disease Self-Management instrument has 17 items grouped into four factors: self-integration, seeking social support, adherence to lifestyle modification and problem solving. The instrument demonstrated good reliability. Self-efficacy was positively correlated with self-management scores, although there was no correlation between chronic kidney disease knowledge and self-management. CONCLUSIONS The Australian version of the Chronic Kidney Disease Self-Management instrument was found to be a valid and reliable patient-reported outcome measure. It can be used in clinical practice to support self-management, as well as future research.
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Affiliation(s)
- Colette Wembenyui
- Kidney Health Service, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QUT School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clint Douglas
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Bonner
- Kidney Health Service, Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QUT School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Molnar AO, Akbari A, Brimble KS. Perceived and Objective Kidney Disease Knowledge in Patients With Advanced CKD Followed in a Multidisciplinary CKD Clinic. Can J Kidney Health Dis 2020; 7:2054358120903156. [PMID: 32110417 PMCID: PMC7016305 DOI: 10.1177/2054358120903156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022] Open
Abstract
Background: One of the key components of multidisciplinary CKD clinics is education;
however, kidney disease knowledge among patients followed in these clinics
is not routinely measured. Objective: The aim of this study was to determine objective and perceived kidney disease
knowledge and patient characteristics associated with knowledge among
patients followed in a multi-care kidney clinic. Design: This is a cross-sectional survey study. Setting: This study was conducted in a multi-care kidney clinic in Ontario,
Canada. Patients: Patients who did not speak English, who were unable to read due to
significant vision impairment, or who had a known history of dementia or
significant cognitive impairment were excluded. Measurements: Perceived kidney disease knowledge was evaluated using a previously validated
9-item survey (PiKS). Each question on the perceived knowledge survey had 4
possible responses, ranging from “I don’t know anything” (1) to “I know a
lot” (4). Objective kidney disease knowledge was evaluated using a
previously validated survey (KiKS). Methods: The association between patient characteristics and perceived and objective
kidney disease knowledge was determined using linear regression. Results: A total of 125 patients were included, 57% were male, the mean (SD) age and
eGFR were 66 (13) years and 16 (5.9) mL/min/1.73 m2,
respectively. The median (IQR) objective and perceived knowledge survey
scores were 19 out of 27 (16, 21) and 2.9 out of 4 (2.4, 3.2), respectively.
Only 25% of patients answered correctly that CKD can be associated with no
symptoms, and 64% of patients identified correctly that the kidneys make
urine. More than 60% of patients perceived themselves to know nothing or
only a little about medications that help or hurt the kidney. Older age was
independently associated with lower perceived and objective knowledge, but
sex, income, and educational attainment were not. Limitations: This is a single-center study. Cognitive impairment was based on the treating
team’s informal assessment or prior documentation in the chart; formal
cognitive testing was not performed as part of this study. Conclusions: Despite resource-intensive care, CKD knowledge of patients followed in a
multidisciplinary clinic was found to be modest. Whether enhanced
educational strategies can improve knowledge and whether increasing
knowledge improves patient outcomes warrants further study.
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Affiliation(s)
- Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada
| | - K Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Sperati CJ, Soman S, Agrawal V, Liu Y, Abdel-Kader K, Diamantidis CJ, Estrella MM, Cavanaugh K, Plantinga L, Schell J, Simon J, Vassalotti JA, Choi MJ, Jaar BG, Greer RC. Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study. PLoS One 2019; 14:e0221325. [PMID: 31437198 PMCID: PMC6705804 DOI: 10.1371/journal.pone.0221325] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/06/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD. STUDY DESIGN Mixed methods study. SETTINGS AND PARTICIPANTS Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. METHODOLOGY We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. ANALYTIC APPROACH We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. RESULTS Of 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. CONCLUSIONS PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD.
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Affiliation(s)
- C. John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sandeep Soman
- Division of Nephrology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Yang Liu
- Johns Hopkins Medicine International, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - Clarissa J. Diamantidis
- Divisions of General Internal Medicine and Nephrology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Kerri Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - Laura Plantinga
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Jane Schell
- Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - James Simon
- Department of Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Joseph A. Vassalotti
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- National Kidney Foundation, New York, New York, United States of America
| | - Michael J. Choi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Nephrology Center of Maryland, Baltimore, Maryland, United States of America
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, United States of America
| | - Raquel C. Greer
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, United States of America
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Potok OA, Nguyen HA, Abdelmalek JA, Beben T, Woodell TB, Rifkin DE. Patients,' Nephrologists,' and Predicted Estimations of ESKD Risk Compared with 2-Year Incidence of ESKD. Clin J Am Soc Nephrol 2019; 14:206-212. [PMID: 30630859 PMCID: PMC6390919 DOI: 10.2215/cjn.07970718] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The rate of progression to ESKD is variable, and prognostic information helps patients and physicians plan for future ESKD. We assessed the estimations of ESKD risk of patients with CKD and physicians and compared them with risk calculators and outcomes at 2 years. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This prospective observational study assessed 257 adult patients with CKD stages 3-5 and their nephrologists at University of California, San Diego and Veterans Affairs San Diego CKD clinics. Patients' and nephrologists' estimations of 2-year ESKD risk were evaluated, and objective estimation of 2-year risk was determined using kidney failure risk equations; actual incidence rates of ESKD and death were ascertained by chart review. Participants' baseline characteristics were compared across kidney failure risk equation risk levels and according to whether patients' estimations were more optimistic or pessimistic than physicians' estimations. We examined correlations between estimations and compared estimations with outcomes using c statistics and calibration plots. RESULTS Average age was 65 (±13) years old, and eGFR was 34 (±13) ml/min per 1.73 m2. Overall, 13% reached ESKD, and 9% died. About one quarter of patients gave estimates that were >20% more optimistic than physicians, and more than one in ten gave estimates that were >20% more pessimistic. Physicians' and kidney failure risk equation estimations had the strongest correlation (r=0.72; P<0.001) compared with 0.50 (P<0.001) between physicians and patients and 0.47 (P<0.001) between patients and kidney failure risk equation. Although all three estimations provided reasonable risk rankings (c statistics >0.8), physicians and patients overestimated risk compared with actual outcomes; no patient whose physician estimated a risk of ESKD <15% reached ESKD at 2 years. The kidney failure risk equation was best calibrated to actual ESKD risk. CONCLUSIONS Compared with actual ESKD incidence, the kidney failure risk equation outperformed patients' and physicians' estimations of ESKD incidence. Patients and physicians overestimated risk compared with the kidney failure risk equation.
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Affiliation(s)
- O. Alison Potok
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California
| | - Hoang Anh Nguyen
- Division of Nephrology-Hypertension, University of California, Irvine, California; and
| | - Joseph A. Abdelmalek
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Tomasz Beben
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Tyler B. Woodell
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California
| | - Dena E. Rifkin
- Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California
- Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California
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Xie Y, Maziarz M, Tuot DS, Chertow GM, Himmelfarb J, Hall YN. Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study. BMC Nephrol 2016; 17:57. [PMID: 27276913 PMCID: PMC4898308 DOI: 10.1186/s12882-016-0272-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/01/2016] [Indexed: 01/13/2023] Open
Abstract
Background The capacity of electronic health record (EHR) data to guide targeted surveillance in chronic kidney disease (CKD) is unclear. We sought to leverage EHR data for predicting risk of progressing from CKD to end-stage renal disease (ESRD) to help inform surveillance of CKD among vulnerable patients from the healthcare safety-net. Methods We conducted a retrospective cohort study of adults (n = 28,779) with CKD who received care within 2 regional safety-net health systems during 1996–2009 in the Western United States. The primary outcomes were progression to ESRD and death as ascertained by linkage with United States Renal Data System and Social Security Administration Death Master files, respectively, through September 29, 2011. We evaluated the performance of 3 models which included demographic, comorbidity and laboratory data to predict progression of CKD to ESRD in conditions commonly targeted for disease management (hypertension, diabetes, chronic viral diseases and severe CKD) using traditional discriminatory criteria (AUC) and recent criteria intended to guide population health management strategies. Results Overall, 1730 persons progressed to end-stage renal disease and 7628 died during median follow-up of 6.6 years. Performance of risk models incorporating common EHR variables was highest in hypertension, intermediate in diabetes and chronic viral diseases, and lowest in severe CKD. Surveillance of persons who were in the highest quintile of ESRD risk yielded 83–94 %, 74–95 %, and 75–82 % of cases who progressed to ESRD among patients with hypertension, diabetes and chronic viral diseases, respectively. Similar surveillance yielded 42–71 % of ESRD cases among those with severe CKD. Discrimination in all conditions was universally high (AUC ≥0.80) when evaluated using traditional criteria. Conclusions Recently proposed discriminatory criteria account for varying risk distribution and when applied to common clinical conditions may help to inform surveillance of CKD in diverse populations. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0272-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuxiang Xie
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Marlena Maziarz
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Delphine S Tuot
- Division of Nephrology, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Glenn M Chertow
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Yoshio N Hall
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA. .,Kidney Research Institute, University of Washington, 325 9th Ave, Box 359606, Seattle, WA, 98104, USA.
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Collister D, Russell R, Verdon J, Beaulieu M, Levin A. Perspectives on optimizing care of patients in multidisciplinary chronic kidney disease clinics. Can J Kidney Health Dis 2016; 3:32. [PMID: 27182444 PMCID: PMC4866402 DOI: 10.1186/s40697-016-0122-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/27/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose of review To summarize a jointly held symposium by the Canadian Society of Nephrology (CSN), the Canadian Association of Nephrology Administrators (CANA), and the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) entitled “Perspectives on Optimizing Care of Patients in Multidisciplinary Chronic Kidney Disease (CKD) Clinics” that was held on April 24, 2015, in Montreal, Quebec. Sources of information The panel consisted of a variety of members from across Canada including a multidisciplinary CKD clinic patient (Randall Russell), nephrology fellow (Dr. David Collister), geriatrician (Dr. Josee Verdon), and nephrologists (Dr. Monica Beaulieu, Dr. Adeera Levin). Findings The objectives of the symposium were (1) to gain an understanding of the goals of care for CKD patients, (2) to gain an appreciation of different perspectives regarding optimal care for patients with CKD, (3) to examine the components required for optimal care including education strategies, structures, and tools, and (4) to describe a framework and metrics for CKD care which respect patient and system needs. This article summarizes the key concepts discussed at the symposium from a patient and physician perspectives. Key messages include (1) understanding patient values and preferences is important as it provides a framework as to what to prioritize in multidisciplinary CKD clinic and provincial renal program models, (2) barriers to effective communication and education are common in the elderly, and adaptive strategies to limit their influence are critical to improve adherence and facilitate shared decision-making, (3) the use of standardized operating procedures (SOPs) improves efficiency and minimizes practice variability among health care practitioners, and (4) CKD scorecards with standardized system processes are useful in approaching variability as well as measuring and improving patient outcomes. Limitations The perspectives provided may not be applicable across centers given the differences in patient populations including age, ethnicity, culture, language, socioeconomic status, education, and multidisciplinary CKD clinic structure and function. Implications Knowledge transmission by collaborative interprovincial and interprofessional networks may play a role in facilitating optimal CKD care. Validation of system and clinic models that improve outcomes is needed prior to disseminating these best practices.
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Affiliation(s)
- David Collister
- Section of Nephrology, University of Manitoba, Winnipeg, MB Canada
| | | | - Josee Verdon
- Division of Geriatric Medicine, McGill University, Montreal, QC Canada
| | - Monica Beaulieu
- Division of Nephrology, University of British Columbia, Vancouver, BC Canada
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, BC Canada
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Watson AR, Hayes WN, Vondrak K, Ariceta G, Schmitt CP, Ekim M, Fischbach M, Edefonti A, Shroff R, Holta T, Zurowska A, Klaus G, Bakkaloglu S, Stefanidis CJ, Van de Walle J. Factors influencing choice of renal replacement therapy in European paediatric nephrology units. Pediatr Nephrol 2013; 28:2361-8. [PMID: 23843162 DOI: 10.1007/s00467-013-2555-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/28/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many factors may impact upon choice of renal replacement therapy (RRT) for children and adolescents, including patient and family choice, patient size and distance from the renal centre as well as logistic issues such as facilities and staffing at the unit. We report a survey of factors influencing treatment choice in 14 European paediatric nephrology units. METHODS A questionnaire was developed by consensus and completed by 14 members of the European Paediatric Dialysis Working Group on facilities, staffing and family assessments impacting on choice of therapy as well as choice of therapy for 97 patients commencing initial RRT in 2011. RESULTS All units offered all modalities of RRT, but there were limitations for pre-emptive transplantation (PET) and largely adult surgical dependence for creation of arteriovenous fistulae and transplantation. The average waiting time for a deceased donor kidney was 18.5 (range 3-36) months. Full time dietetic support was available in six of the 14 units. There was no social worker, psychology, play therapy or teaching support in three, two, seven and four units, respectively. Assessment by other members of the multidisciplinary team and home visits before choice of therapy was carried out in 50 % of units, and although all patients were discussed at team meetings, the medical opinion predominated. In terms of types of RRT, 50 % of patients were commenced on chronic peritoneal dialysis (PD), 34 % on haemodialysis (HD) and 16 % underwent pre-emptive transplantation (PET). Chronic PD predominated in patients aged <5 years and HD predominated in those aged >10 years. Patient and family choice and age or size of patient were predominant factors in choice of therapy with a predictable decline in renal function favouring PET and social factors HD. CONCLUSIONS Chronic peritoneal dialysis predominated as primary choice of RRT, especially in younger children. The PET rates remain low. The influence of surgeons predominanted, and national transplant rules may be significant. Most units had insufficient multiprofessional support, which may impact upon initial choice of therapy as well as sustaining families through RRT.
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Affiliation(s)
- Alan R Watson
- Children's Renal & Urology Unit, Nottingham Children's Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK,
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11
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Abstract
OBJECTIVE This study evaluated the number of Stage 4 chronic kidney disease (CKD) education classes taught by physician assistants (PAs) and NPs. METHODS Descriptive analysis of data from the CMS Public Use File were calculated for 2010-2011 kidney disease education classes with particular focus on PAs and NPs. RESULTS In 2010, 4,580 individual and 1,612 group classes were held; one-third of individual classes and two-thirds of group classes were taught by PAs and NPs. In 2011, with a 32% increase in classes, the percentages of PA and NP instructors stayed the same. PAs and NPs predominantly teach home classes, group classes, and outpatient hospital classes. CONCLUSIONS Less than 7% of eligible patients were offered education classes in 2010-2011. An examination of Medicare billing data shows PAs and NPs are underused in patient education, an area in which they are uniquely qualified.
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Kong X, Liu L, Zuo L, Yuan P, Li Z, Li W, Cai M, Chen X, Jiang A, Long G, Xu J, Lin H, Wang S, Huang W, Wang Y, Guo Y, Cao P, Wu H, Jia Q, Zhang L, Wang M, Wang H. Association between family members of dialysis patients and chronic kidney disease: a multicenter study in China. BMC Nephrol 2013; 14:19. [PMID: 23331610 PMCID: PMC3565899 DOI: 10.1186/1471-2369-14-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/07/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Family members of patients with end stage renal disease were reported to have an increased prevalence of chronic kidney disease (CKD). However, studies differentiated genetic and non-genetic family members are limited. We sought to investigate the prevalence of CKD among fist-degree relatives and spouses of dialysis patients in China. METHODS Seventeen dialysis facilities from 4 cities of China including 1062 first-degree relatives and 450 spouses of dialysis patients were enrolled. Sex- and age- matched controls were randomly selected from a representative sample of general population in Beijing. CKD was defined as decreased estimated glomerular (eGFR<60 mL/min/1.73 m2) or albuminuria. RESULTS The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis spouses were compared with their counterpart controls, which was 3.8% vs. 7.8% (P<0.01), 16.8% vs. 14.6% (P=0.29) and 18.4% vs. 19.8% (P=0.61), respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis relatives were also compared with their counterpart controls, which was 1.5% vs. 2.4% (P=0.12), 14.4% vs. 8.4% (P<0.01) and 14.6% vs. 10.5% (P<0.01), respectively. Multivariable Logistic regression analysis indicated that being spouses of dialysis patients is negatively associated with presence of low eGFR, and being relatives of dialysis patients is positively associated with presence of albuminuria. CONCLUSIONS The association between being family members of dialysis patients and presence of CKD is different between first-degree relatives and spouses. The underlying mechanisms deserve further investigation.
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Affiliation(s)
- Xianglei Kong
- Renal Division, Department of Medicine, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, China
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Martin P. Finding a living kidney donor: experiences of New Zealand renal patients. AUST HEALTH REV 2013; 37:48-53. [DOI: 10.1071/ah12159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/19/2012] [Indexed: 11/23/2022]
Abstract
A living donor kidney transplant (LDKT) is the preferred treatment for many people with end stage renal failure but there is a significant and growing gap between the number of people who might benefit from a transplant and those who receive one in New Zealand. International research suggests a range of barriers for patients in the journey to LDKT. One hundred and ninety-three patients on the New Zealand waiting list for a kidney transplant responded to a postal survey about live transplantation. While many patients are willing to discuss LDKT with family and friends, most are reluctant to go on to ask others directly to consider live donation. Patients who have not discussed LDKT with others are significantly less likely to have received even one offer from a potential donor. Pākehā and Māori are more likely to have received an offer to donate and to have had someone go on to be tested for compatibility than either Pacific or Other ethnic groups. Information gaps, ineffective donor recruitment strategies, donor incompatibility and donor medical unsuitability appear to be major barriers to LDKT. Many barriers are amenable to intervention and the implications for policy and practice are discussed.
What is known about the topic?
International studies suggest donor recruitment is difficult for patients and is a major barrier to LDKT. Incompatibility and medical unsuitability are barriers for many willing potential donors. There is no previous patient-centred NZ research on the barriers to living donor kidney transplantation (LDKT).
What does this paper add?
The paper provides evidence about patterns of donor recruitment activity amongst NZ patients, and suggests a strong relationship between discussing LDKT with family and friends, and receiving offers from potential donors. Asking potential donors directly to consider donation, as opposed to just discussing LDKT in general, does not seem to be associated with receiving more offers. Differences among ethnic groups can be seen.
What are the implications for practitioners?
Many of the barriers to LDKT are amenable to intervention, and possible options, such as support for donor recruitment and boosting NZ’s paired exchange scheme, are identified.
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