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Novick TK, Osuna M, Emery C, Barrios F, Ramirez D, Crews DC, Jacobs EA. Patients' Perspectives on Health-Related Social Needs and Recommendations for Interventions: A Qualitative Study. Am J Kidney Dis 2024; 83:739-749. [PMID: 38218454 PMCID: PMC11116062 DOI: 10.1053/j.ajkd.2023.11.005] [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: 07/24/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 01/15/2024]
Abstract
RATIONALE & OBJECTIVE People with low socioeconomic status are disproportionately affected by kidney failure, and their adverse outcomes may stem from unmet health-related social needs. This study explored hemodialysis patient perspectives on health-related social needs and recommendations for intervention. STUDY DESIGN Qualitative study using semistructured interviews. SETTINGS & PARTICIPANTS Thirty-two people with low socioeconomic status receiving hemodialysis at 3 hemodialysis facilities in Austin, Texas. ANALYTICAL APPROACH Interviews were analyzed for themes and subthemes using the constant comparative method. RESULTS Seven themes and 21 subthemes (in parentheses) were identified: (1) kidney failure was unexpected (never thought it would happen to me; do not understand dialysis); (2) providers fail patients (doctors did not act; doctors do not care); (3) dialysis is detrimental (life is not the same; dialysis is all you do; dialysis causes emotional distress; dialysis makes you feel sick); (4) powerlessness (dependent on others; cannot do anything about my situation); (5) financial resource strain (dialysis makes you poor and keeps you poor; disability checks are not enough; food programs exist but are inconsistent; eat whatever food is available; not enough affordable housing; unstable housing affects health and well-being); (6) motivation to keep going (faith, support system, will to live); and (7) interventions should promote self-efficacy (navigation of community resources, support groups). LIMITATIONS Limited quantitative data such as on dialysis vintage, and limited geographic representation. CONCLUSIONS Dialysis exacerbates financial resource strain, and health-related social needs exacerbate dialysis-related stress. The participants made recommendations to address social needs with an emphasis on increasing support and community resources for this population. PLAIN-LANGUAGE SUMMARY People receiving dialysis often experience health-related social needs, such as food and housing needs, but little is known about how these impact patients' health and well-being or how to best address them. We interviewed people receiving dialysis about how health-related social needs affect them and what they think dialysis facilities can do to help them address those needs. The participants reported that they often lose their independence after starting dialysis and health-related social needs are common, exacerbate their stress and emotional distress, and reduce their sense of well-being. Dialysis facilities may be able to enhance the experience of these patients by facilitating connections with local resources and providing opportunities for patients to support one another.
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Affiliation(s)
- Tessa K Novick
- Division of Nephrology, Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas.
| | | | | | - Francisco Barrios
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Daniel Ramirez
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth A Jacobs
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas; MaineHealth, Portland, Maine
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Nishio Lucar AG, Patel A, Mehta S, Yadav A, Doshi M, Urbanski MA, Concepcion BP, Singh N, Sanders ML, Basu A, Harding JL, Rossi A, Adebiyi OO, Samaniego-Picota M, Woodside KJ, Parsons RF. Expanding the access to kidney transplantation: Strategies for kidney transplant programs. Clin Transplant 2024; 38:e15315. [PMID: 38686443 DOI: 10.1111/ctr.15315] [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: 11/14/2023] [Revised: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
Kidney transplantation is the most successful kidney replacement therapy available, resulting in improved recipient survival and societal cost savings. Yet, nearly 70 years after the first successful kidney transplant, there are still numerous barriers and untapped opportunities that constrain the access to transplant. The literature describing these barriers is extensive, but the practices and processes to solve them are less clear. Solutions must be multidisciplinary and be the product of strong partnerships among patients, their networks, health care providers, and transplant programs. Transparency in the referral, evaluation, and listing process as well as organ selection are paramount to build such partnerships. Providing early culturally congruent and patient-centered education as well as maximizing the use of local resources to facilitate the transplant work up should be prioritized. Every opportunity to facilitate pre-emptive kidney transplantation and living donation must be taken. Promoting the use of telemedicine and kidney paired donation as standards of care can positively impact the work up completion and maximize the chances of a living donor kidney transplant.
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Affiliation(s)
- Angie G Nishio Lucar
- Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA
| | - Ankita Patel
- Recanati-Miller Transplantation Institute, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shikha Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anju Yadav
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mona Doshi
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan A Urbanski
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Neeraj Singh
- Willis Knighton Health System, Shreveport, Louisiana, USA
| | - M Lee Sanders
- Department of Internal Medicine, Division of Nephrology, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Arpita Basu
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica L Harding
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia, USA
| | - Oluwafisayo O Adebiyi
- Department of Medicine, Indiana University Health Hospital, Indianapolis, Indiana, USA
| | | | | | - Ronald F Parsons
- Department of Surgery, University of Pennsylvannia, Philadelphia, Pennsylvania, USA
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Noya-Mourullo A, Martín-Parada A, Palacios-Hernández A, Eguiluz-Lumbreras P, Heredero-Zorzo Ó, García-Gómez F, Álvarez-Ossorio-Fernández JL, Álvarez-Ossorio-Rodal A, Márquez-Sánchez MT, Flores-Fraile J, Fraile-Gómez P, Padilla-Fernández BY, Lorenzo-Gómez MF. Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs. J Pers Med 2024; 14:408. [PMID: 38673035 PMCID: PMC11051259 DOI: 10.3390/jpm14040408] [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: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. AIMS To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. METHODS Retrospective observational multicentre study. SAMPLE Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). RESULTS Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50-42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. CONCLUSIONS Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.
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Affiliation(s)
- Andrea Noya-Mourullo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Alejandro Martín-Parada
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Alberto Palacios-Hernández
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Pablo Eguiluz-Lumbreras
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Óscar Heredero-Zorzo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Francisco García-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | | | | | | | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Pilar Fraile-Gómez
- Nephrology Department, University Hospital of Salamanca, 37007 Salamanca, Spain;
| | | | - María-Fernanda Lorenzo-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
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Davis WA, Chakera A, Gregg E, McAullay D, Davis TME. Temporal Trends in Renal Replacement Therapy in Community-Based People with or without Type 2 Diabetes: The Fremantle Diabetes Study. J Clin Med 2022; 11:jcm11030695. [PMID: 35160152 PMCID: PMC8837160 DOI: 10.3390/jcm11030695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Although rates of cardiovascular disease complicating type 2 diabetes are declining, equivalent data for renal replacement therapy (RRT) are conflicting. The aim of this study was to characterize temporal changes in RRT incidence rates (IRs) in Australians with or without type 2 diabetes. Methods: Participants with type 2 diabetes from the Fremantle Diabetes Study Phases I (FDS1; n = 1291 recruited 1993–1996) and II (FDS2; n = 1509 recruited 2008–2011) were age-, sex- and postcode-matched 1:4 to people without diabetes and followed for first hospitalization for/with RRT. Five-year IRs, IR ratios (IRRs) for those with versus without diabetes in FDS1 and FDS2, and IR differences (IRDs), were calculated. Results: The 13,995 participants had a mean age of 64.8 years and 50.4% were males. For the type 2 diabetes cohorts, the 5-year RRT IR was nearly threefold higher in FDS2 versus FDS1 (IRR (95% CI): 2.85 (1.01–9.87)). Sixteen more participants with type 2 diabetes/10,000 person-years received RRT in FDS2 than FDS1 compared with an IRD of 2/10,000 person-years in those without diabetes. Type 2 diabetes increased RRT risk at least 5-fold. This increased risk was greater in Aboriginal participants who were relatively young when RRT was initiated and more prone to rapid progression to RRT. Multivariable analysis using the combined FDS type 2 diabetes cohorts confirmed albuminuria as a strong independent RRT risk factor. Conclusions: The incidence of RRT is increasing substantially in Australians with type 2 diabetes, especially in Aboriginals who progress to RRT more rapidly at a younger age than non-Aboriginals.
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Affiliation(s)
- Wendy A. Davis
- Medical School, The University of Western Australia, Crawley, WA 6009, Australia; (W.A.D.); (A.C.)
| | - Aron Chakera
- Medical School, The University of Western Australia, Crawley, WA 6009, Australia; (W.A.D.); (A.C.)
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Edward Gregg
- School of Public Health, Imperial College London, London SW7 2BX, UK;
| | - Daniel McAullay
- Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Edith Cowan University, Mount Lawley, WA 6050, Australia;
| | - Timothy M. E. Davis
- Medical School, The University of Western Australia, Crawley, WA 6009, Australia; (W.A.D.); (A.C.)
- Correspondence: ; Tel.: +61-(8)-94-313-229; Fax: +61-(8)-94-312-977
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Marques J, Pereira L, Messias A, Fonseca N, Cotovio P, Ferreira A, Nolasco F. The burden of coronary heart disease in simultaneous pancreas-kidney transplantation: coronary angiography as a diagnostic method for all? - a retrospective study. J Bras Nefrol 2022; 44:522-526. [PMID: 35258070 PMCID: PMC9838668 DOI: 10.1590/2175-8239-jbn-2021-0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/13/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus is associated with an increased risk of coronary artery disease, which is frequently asymptomatic. This risk increases significantly in those with nephropathy. In selected patients, simultaneous pancreas-kidney transplantation is the renal and pancreatic replacement therapy of choice, as it increases longevity and stabilizes diabetic complications. Despite essential, universal screening protocols are still controversial for coronary artery disease in this population. METHODS We retrospectively analysed 99 simultaneous pancreas-kidney recipients from our centre from 2011 to 2018 and selected 77 patients who underwent coronary angiography during the pre-transplant evaluation. Our aim was to identify potential risk factors associated with significant lesions on coronary angiography. RESULTS Almost half of our cohort of 77 candidates submitted to coronary angiography had coronary artery disease. Of these, nearly 30% underwent revascularization, although only one of them reported symptoms of myocardial ischemia. In a univariate analysis, the presence of smoking habits was the only risk factor for coronary artery disease. We also found that 20 or more years of type 1 diabetes mellitus was significantly associated with the presence of coronaropathy. DISCUSSION Selection of diabetic candidates with acceptable cardiac risk before simultaneous pancreas-kidney transplantation is imperative. Given the impact of a correct diagnosis and a low procedural risk, we defend the routine use of coronary angiography as the initial screening method for coronary artery disease in this population. Particularly care must be taken in evaluating asymptomatic patients with long-term type 1 diabetes mellitus and smokers.
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Affiliation(s)
- Joana Marques
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Luísa Pereira
- Centro Hospitalar Universitário do Algarve, Serviço de Nefrologia,
Faro, Portugal
| | - Ana Messias
- Hospital Garcia de Orta, Serviço de Nefrologia, Almada,
Portugal
| | - Nuno Fonseca
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Patrícia Cotovio
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Aníbal Ferreira
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal.,Nova Medical School, Hospital Curry Cabral, Serviço de Nefrologia,
Lisboa, Portugal
| | - Fernando Nolasco
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal.,Nova Medical School, Hospital Curry Cabral, Serviço de Nefrologia,
Lisboa, Portugal
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