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Wong JV, Yang GJ, Auguste BL, Ong SW, Logan AG, Chan CT, Nolan RP. Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life. KIDNEY360 2023; 4:1397-1406. [PMID: 37578528 PMCID: PMC10615379 DOI: 10.34067/kid.0000000000000229] [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: 02/02/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Key Points Feasibility of implementing an automated, scalable, digital self-care program for patients with CKD was established. The primary outcome of improvement in health-related quality of life improved with the ODYSSEE-Kidney Health program. A dose relationship was shown between program engagement tertile and improvement in 4-month outcomes. Background In-person counseling programs promote self-care behavior and health-related quality of life (HRQoL). ODYSSEE-Kidney Health (prO moting health with D igitallY based counS eling for S elf-care bE havior and quality of lifE ; ODYSSEE-KH) is an automated, scalable, digital counseling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of the ODYSSEE-KH program to improve HRQoL in patients with CKD. Methods Adults with categories G3b to 5d CKD were recruited from nephrology clinics in Toronto, Canada. Patients (N =29) received access to the ODYSSEE-KH program in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life–Short Form instrument. Secondary outcomes included the MCS Mental Health Scale, 36-Item Kidney Disease Quality of Life–Short Form, Generalized Anxiety Disorder Scale, Patient Health Questionnaire for depression, Enhancing Recovery in Coronary Heart Disease Social Support Instrument, and 3-Item Revised University of California, Los Angeles (UCLA) Loneliness Scale. Results The mean age of the patients was 53.5 years (SD=18.3); 35% were women; 56% were White; 93% had completed ≥postsecondary education; patients came from the Multi-Care Kidney Clinic (n =9), Home Peritoneal Dialysis Unit (n =12), and Home Hemodialysis Unit (n =8); and 24 participants completed the 4-month end-of-study questionnaires. Outcomes were assessed according to tertiles of program log-on minutes: median (range)=67 (62–108), 212 (119–355), and 500 (359–1573) minutes, respectively. Patients in the highest tertile of engagement showed significant improvements on the MCS versus the moderate tertile group (P = 0.01). Significant dose-response associations were observed for the MCS Mental Health Scale (P < 0.05), KDQoL Burden on Kidney Disease (P < 0.01), KDQoL Effect of Kidney Disease on Everyday Life (P < 0.01), aggregated KDQoL Summary Scale (P < 0.05), Generalized Anxiety Disorder Scale (P < 0.01), Patient Health Questionnaire for Depression (P < 0.05), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (P < 0.01), and 3-Item Revised UCLA Loneliness Scale (P < 0.01). Conclusion The ODYSSEE-KH program demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of its efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.
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Affiliation(s)
- Julia V Wong
- Cardiac eHealth , Peter Munk Cardiac Centre , University Health Network , Toronto , Ontario , Canada
- Institute of Health Policy, Management, and Evaluation , University of Toronto , Dalla Lana School of Public Health , Toronto , Ontario , Canada
| | - Grace J Yang
- Cardiac eHealth , Peter Munk Cardiac Centre , University Health Network , Toronto , Ontario , Canada
| | - Bourne L Auguste
- Division of Nephrology , Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada
- Division of Nephrology , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
| | - Stephanie W Ong
- Connected Care , University Health Network , Toronto , Ontario , Canada
- Toronto General Hospital Research Institute , University Health Network , Toronto , Ontario , Canada
- Division of Nephrology , University Health Network , Toronto , Ontario , Canada
- Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Alexander G Logan
- Division of Nephrology , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
- Division of Nephrology , University Health Network , Toronto , Ontario , Canada
- Lunenfeld-Tanenbaum Research Institute , Sinai Health , Toronto , Ontario , Canada
- Institute of Medical Science , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
| | - Christopher T Chan
- Division of Nephrology , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
- Connected Care , University Health Network , Toronto , Ontario , Canada
- Toronto General Hospital Research Institute , University Health Network , Toronto , Ontario , Canada
- Division of Nephrology , University Health Network , Toronto , Ontario , Canada
| | - Robert P Nolan
- Cardiac eHealth , Peter Munk Cardiac Centre , University Health Network , Toronto , Ontario , Canada
- Toronto General Hospital Research Institute , University Health Network , Toronto , Ontario , Canada
- Institute of Medical Science , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
- Ted Rogers Centre of Excellence in Heart Function , Peter Munk Cardiac Centre , University Health Network , Toronto , Ontario , Canada
- Department of Psychiatry , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada
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Girardin FR, Nicolet A, Bestard O, Lefaucheur C, Budde K, Halleck F, Brouard S, Giral M, Gourraud PA, Horcholle B, Villard J, Marti J, Loupy A. Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN). Front Pharmacol 2023; 14:1040584. [PMID: 37180729 PMCID: PMC10174308 DOI: 10.3389/fphar.2023.1040584] [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: 09/09/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in international settings. Methods: In a prospective, multi-centric cohort study, including nine transplant centers in four countries, we explored the QoL during the year following transplantation using validated elicitation instruments (EQ-5D-3L index with VAS) in a population of kidney transplant patients receiving immunosuppressive therapies. Calcineurin inhibitors (tacrolimus and ciclosporin), IMPD inhibitor (mycophenolate mofetil), and mTOR inhibitors (everolimus and sirolimus) were the standard-of-care (SOC) medications, together with tapering glucocorticoid therapy. We used EQ-5D and VAS data as QoL measures alongside descriptive statistics at inclusion, per country and hospital center. We computed the proportions of patients with different immunosuppressive therapy patterns, and using bivariate and multivariate analyses, assessed the variations of EQ-5D and VAS between baseline (i.e., inclusion Month 0) and follow up visits (Month 12). Results: Among 542 kidney transplant patients included and followed from November 2018 to June 2021, 491 filled at least one QoL questionnaire at least at baseline (Month 0). The majority of patients in all countries received tacrolimus and mycophenolate mofetil, ranging from 90.0% in Switzerland and Spain to 95.8% in Germany. At M12, a significant proportion of patients switched immunosuppressive drugs, with proportion varying from 20% in Germany to 40% in Spain and Switzerland. At visit M12, patients who kept SOC therapy had higher EQ-5D (by 8 percentage points, p < 0.05) and VAS (by 4 percentage points, p < 0.1) scores than switchers. VAS scores were generally lower than EQ-5D (mean 0.68 [0.5-0.8] vs. 0.85 [0.8-1]). Discussion: Although overall a positive trend in QoL was observed, the formal analyses did not show any significant improvements in EQ-5D scores or VAS. Only when the effect of a therapy use was separated from the effect of switching, the VAS score was significantly worse for switchers during the follow up period, irrespective of the therapy type. If adjusted for patient characteristics and medical history (e.g., gender, BMI, eGRF, history of diabetes), VAS and EQ-5D delivered sound PRO measures for QoL assessments during the year following renal transplantation.
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Affiliation(s)
- François R. Girardin
- Division of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Faculty of Medicine, University of Lausanne, Lausanne, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- *Correspondence: François R. Girardin, ; Anna Nicolet,
| | - Anna Nicolet
- Center for Primary Care and Public Health (UniSanté), University of Lausanne, Lausanne, Switzerland
- *Correspondence: François R. Girardin, ; Anna Nicolet,
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Lefaucheur
- Kidney Transplant Department, Saint Louis Hospital, Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
| | - Klemens Budde
- Department of Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Intensive Care, Charité Virchow Clinic, University Hospital, Berlin, Germany
| | - Sophie Brouard
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Magali Giral
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Pierre-Antoine Gourraud
- Nantes Université, INSERM, CRT2I—Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Béatrice Horcholle
- Kidney Transplant Department, Saint Louis Hospital, Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Villard
- Transplantation Immunology Unit, National Reference Laboratory for Histocompatibility, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joachim Marti
- Center for Primary Care and Public Health (UniSanté), University of Lausanne, Lausanne, Switzerland
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
- Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Neri L, Ponce P, Matias N, Stuard S, Cromm K. Clinical target achievement is associated with better quality of life among dialysis patients: results from a continuous quality improvement program in a Portuguese healthcare network. Qual Life Res 2020; 29:2705-2714. [DOI: 10.1007/s11136-020-02543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
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Dano S, Pokarowski M, Liao B, Tang E, Ekundayo O, Li V, Edwards N, Ford H, Novak M, Mucsi I. Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study. Transpl Int 2020; 33:423-436. [PMID: 31919903 DOI: 10.1111/tri.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.
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Affiliation(s)
- Sumaya Dano
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Betty Liao
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vernon Li
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Heather Ford
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
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Levy AR, Xing S, Brunelli SM, Cooper K, Finkelstein FO, Germain MJ, Kimel M, Platt RW, Belozeroff V. Symptoms of Secondary Hyperparathyroidism in Patients Receiving Maintenance Hemodialysis: A Prospective Cohort Study. Am J Kidney Dis 2019; 75:373-383. [PMID: 31629575 DOI: 10.1053/j.ajkd.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/17/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although multiple lines of evidence suggest a negative impact of secondary hyperparathyroidism on patients with kidney failure treated by hemodialysis, it is uncertain whether patients can detect associated symptoms. The objective was to determine whether changes in parathyroid hormone (PTH) levels are associated with changes in symptoms within this patient population. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 165 adults with hyperparathyroidism secondary to kidney failure diagnosed, a range of dialysis vintages, and receiving regular hemodialysis from a US single-provider organization. EXPOSURE Change in PTH levels over 24 weeks. OUTCOMES 19 putative symptoms of secondary hyperparathyroidism measured up to 4 times using a self-administered questionnaire that assessed severity on a 5-level ordinal scale. ANALYTICAL APPROACH Longitudinal associations between changes in PTH levels and symptom severity were assessed using generalized additive models. RESULTS The 165 participants studied represented 81% of enrollees (N=204) who had sufficiently complete data for analysis. Mean age was 56 years and 54% were women. Increases in PTH levels over time were associated (P<0.1) with worsening of bone aches and stiffness, joint aches, muscle soreness, overall pain, itchy skin, and tiredness, and the effects were more pronounced with larger changes in PTH levels. LIMITATIONS Findings may have been influenced by confounding by unmeasured comorbid conditions, concomitant medications, and multiple testing coupled with a P value threshold of 0.10. CONCLUSIONS In this exploratory study, we observed that among patients with secondary hyperparathyroidism, increases in PTH levels over time were associated with worsening of 1 or more cluster of symptoms. Replication of these findings in other populations is needed before concluding about the magnitude and shape of these associations. If replicated, these findings could inform clinically useful approaches for measuring patient-reported outcomes related to secondary hyperparathyroidism.
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Affiliation(s)
| | - Shan Xing
- Takeda Pharmaceuticals U.S.A, Cambridge, MA
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