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Suarez-Rivero JM, López-Pérez J, Astorga-Gamaza A, Muela-Zarzuela I, de la Varga-Martínez R, Aguilera A, Garcia T, Mazuecos A, Cordero MD. Does NLRP1 Inflammasome Activation in Immune Cells in Kidney Transplantation Relate with Donor Organ Age? Antioxid Redox Signal 2024. [PMID: 38497710 DOI: 10.1089/ars.2024.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Inflammation causes a wide range of health disorders. In this process, the formation of inflammasome complexes plays a key role. Although inflammasomes have been extensively studied during kidney disease, their role in kidney transplantation has not been fully elucidated. In this study, we evaluate the gene and protein expression of several components of the inflammasome pathway before and at several time points after kidney transplantation in a cohort of patients of different ages and receiving an organ from older or younger donors. Our findings indicate the activation of the NLRP1 inflammasome in several immune cell population, monocytes and CD4+ and CD8+ cells mainly, in renal transplant, and its level increases gradually in patients who receive an older organ, whereas it has the opposite effect on older patients who receive a younger organ. Despite treatment with immunosuppressants, inflammation persists in some patients. These results lead to the hypothesis that the donor's age is a critical factor in post-transplant inflammasome activation and that specific NLRP1 inflammasome inhibitors should be considered to increase the success of kidney transplantation long-term.
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Affiliation(s)
- Juan Miguel Suarez-Rivero
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
| | - Juan López-Pérez
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Department of Immunology, Puerta del Mar Hospital, Cádiz, Spain
| | - Antonio Astorga-Gamaza
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
| | - Inés Muela-Zarzuela
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
| | - Raquel de la Varga-Martínez
- Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Department of Immunology, Puerta del Mar Hospital, Cádiz, Spain
| | - Aurora Aguilera
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Teresa Garcia
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | | | - Mario D Cordero
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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2
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Ceyhan Y, Soylu D. Moderator Effect of Transplant Waiting Time on the Relationship Between Hopelessness and Death Anxiety in Patients Waiting for Organ Transplant. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:785-806. [PMID: 37853600 DOI: 10.1177/00302228231208389] [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: 10/20/2023]
Abstract
The study aimed to examine the moderator effect of organ transplant waiting time on hopelessness and death anxiety. The study was conducted in a descriptive and correlational design with 378 patients on the transplant waiting list (Agust 2021- March 2022). Multiple linear regression and PROCESS macro-Model 1 were used in the analyses. In this study, the STROBE checklist was followed. According to the results of the regression analysis, waiting for a transplant for 6-10 years reduced death anxiety by 9.38 times and waiting for a transplant for 16-20 years increased death anxiety by 31.3 times. The predictors in the regression analysis explained 33% of the model. The moderator effect constituted 6.4% of the explained part of the model, which was 25.4%; the R2 change was 3.4% and significant. We found that the longer the waiting period for organ transplant recipients, the higher the hopelessness and death anxiety.
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Affiliation(s)
- Yasemin Ceyhan
- Department of Nursing, Faculty of Health Sciences, Kırşehir Ahi Evran University, Kirsehir, Turkey
| | - Dilek Soylu
- Renal Transplantation Center, Health Application and Research Hospital, Kahramanmaras, Sütçü Imam University, Kahramanmaras, Turkey
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3
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Pedreira‐Robles G, Garcimartín P, Bach‐Pascual A, Giró‐Formatger D, Redondo‐Pachón D, Morín‐Fraile V. Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis. Nurs Open 2023; 10:6668-6689. [PMID: 37480193 PMCID: PMC10495730 DOI: 10.1002/nop2.1937] [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: 01/02/2023] [Revised: 05/21/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
AIMS To analyse the aspects involved in the care of individuals assessed as kidney transplant candidates and to identify the role of nurses in providing specialised care for this population. DESIGN Scoping review. The results were summarised using a narrative synthesis technique. DATA SOURCES A review of the literature published between 2001 and 2021 was conducted between October and November 2021 using PubMed, CINAHL and SciELO. REVIEW METHODS The research team agreed on a search strategy based on clinical practice guidelines for assessing kidney transplantation candidates. Quantitative, qualitative and mixed methods studies published in peer-reviewed journals in English, Spanish, French and Portuguese were included. RESULTS A total of 377 studies were identified, and 49 articles were included after the inclusion and exclusion criteria were applied. The narrative synthesis was structured into four themes: Physical needs; Psychological and quality of life needs; Education and adherence needs; and Nurses' role. CONCLUSION Nursing assessment of kidney transplantation candidates should encompass physical, psychosocial and adherence aspects. A variety of methodologies and resources are available for this assessment. Nurses contribute to coordinating access to kidney transplantation, aiming to improve adherence to an appropriate lifestyle to prevent patients from being excluded from kidney transplantation or suffering from kidney transplantation-related complications. IMPACT Based on our findings, we managed to design a nursing care map for kidney transplantation candidates combining the main elements of nursing care that should be incorporated into this process. Advanced practice nursing professionals play a crucial role in accessing renal transplant care.
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Affiliation(s)
- Guillermo Pedreira‐Robles
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- ESIMar (Mar Nursing School)Parc de Salut Mar, Universitat Pompeu Fabra affiliatedBarcelonaSpain
- SDHEd (Social Determinants and Health Education Research Group)IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Nursing and Health PhD ProgramUniversity of BarcelonaBarcelonaSpain
| | - Paloma Garcimartín
- Nursing DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- Research Group in Nursing CareIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Biomedical Network Research Center for Cardiovascular DiseasesCIBERCV, Carlos III Health InstituteMadridSpain
| | - Anna Bach‐Pascual
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
| | - Dolors Giró‐Formatger
- Nursing Care Methodology and Quality departmentHospital del Mar, Parc de Salut MarBarcelonaSpain
| | - Dolores Redondo‐Pachón
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- Kidney Research Group (GREN)Hospital del Mar Institute for Medical Research (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN)BarcelonaSpain
| | - Victoria Morín‐Fraile
- Department of Public Health, Mental and Maternal and Child Health, Nursing schoolUniversity of BarcelonaBarcelonaSpain
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Biabani F, Rahmani A, MahmudiRad G, Hassankhani H, Azadi A. Reasons for kidney transplant refusal among patients receiving peritoneal dialysis: A qualitative study. Perit Dial Int 2023; 43:395-401. [PMID: 36601692 DOI: 10.1177/08968608221146865] [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: 01/06/2023] Open
Abstract
BACKGROUND Even though kidney transplantation has better outcomes compared to dialysis therapies, some patients undergoing peritoneal dialysis (PD) refuse to consider kidney transplantation. Identification of the underlying reason for patient refusal may improve patients' acceptance of kidney transplantation. AIM The aim of this study was to describe the reasons given by Iranian PD patients for refusing kidney transplantation. METHOD Eighteen patients undergoing PD participated. Data were collected using semi-structured interviews and were analysed using conventional qualitative content analysis. RESULTS The analysis leads to the emergence of two categories and six subcategories: negative outcomes of kidney transplantation (financial burden, psychosocial problems and physical complications) and doubtful factors for kidney transplantation (negative attitudes towards kidney transplantation, long waiting time for kidney transplantation and compatibility of PD with daily life). The financial burden and long waiting time for kidney transplantation were the most important factors in the reluctance of kidney transplantation by PD patients. IMPLICATION FOR PRACTICE Patients undergoing PD declined kidney transplantation for several reasons, such as financial burden, fear of post-transplantation side effects, long waiting time for kidney transplantation. Reducing the time of kidney transplantation and insurance coverage of transplant costs can change the attitude of PD patients towards transplant.
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Affiliation(s)
- Fateme Biabani
- Nursing and Midwifery Faculty, Birjand University of Medical Sciences, Iran
| | - Azad Rahmani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Iran
| | | | - Hadi Hassankhani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Iran
| | - Arman Azadi
- Nursing Department, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Iran
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5
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Jones EL, Shakespeare K, McLaughlin L, Noyes J. Understanding people's decisions when choosing or declining a kidney transplant: a qualitative evidence synthesis. BMJ Open 2023; 13:e071348. [PMID: 37562929 PMCID: PMC10423837 DOI: 10.1136/bmjopen-2022-071348] [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: 01/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To synthesise qualitative research exploring patients' perspectives, experiences and factors influencing their decision-making preferences when choosing or declining kidney transplantation. DESIGN A qualitative evidence synthesis. DATA SOURCES Electronic databases were searched from 2000 to June 2021: PubMed, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, ProQuest Core Databases for Dissertations and Theses, and Google Scholar. ELIGIBILITY CRITERIA Qualitative studies exploring and reporting decision-making preferences of people with kidney disease, which reported influencing factors when choosing or declining kidney transplantation, published in English from high-income and middle-income countries. DATA EXTRACTION AND SYNTHESIS Titles were screened against the inclusion criteria. Thematic synthesis was done with the use of the Critical Appraisal Skills Programme qualitative checklist to assess study quality, and assessment of confidence in the qualitative findings was done using the Grading of Recommendation, Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research. FINDINGS 37 studies from 11 countries reported the perspectives of 1366 patients with kidney disease. Six descriptive themes were developed: decisional preferences influenced patients' readiness to pursue kidney transplantation, gathering sufficient information to support decision-making, navigating the kidney transplant assessment pathway, desire for kidney transplantation, opposed to kidney transplantation and uncertainties while waiting for the kidney transplant. A new enhanced theoretical model was developed to aid understanding of the complexities of decision-making in people with kidney disease, by integrating the Theory of Planned Behaviour and the Adaptive Decision Maker Framework to incorporate the novel findings. CONCLUSION The synthesis provides a better understanding of the extremely complex decision-making processes of people with kidney disease, which are aligned to their kidney transplantation preferences. Further research is needed to better understand the reasons for declining kidney transplantation, and to underpin development of personalised information, interventions and support for patients to make informed decisions when presented with kidney replacement options. PROSPERO REGISTRATION NUMBER CRD42021272588.
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Affiliation(s)
- Emma Louise Jones
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kate Shakespeare
- Betsi Cadwaladr University Health Board, Clinical Psychology Dept, Royal Alexandra Hospital, Rhyl, UK
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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6
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Nilsson K, Westas M, Andersson G, Johansson P, Lundgren J. Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:2422-2428. [PMID: 35272905 DOI: 10.1016/j.pec.2022.02.016] [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: 06/08/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The study aimed to explore and describe patients' experiences of the transplantation process and the support they had received during the waiting time. METHOD Semi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis. RESULTS Two themes and seven sub-themes were identified. The first theme, "Swaying between hope and despair" describes patients' perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, "Making your way through the waiting time", describes support, strategies and behaviours used to manage the waiting time. CONCLUSION Patients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences. PRACTICE IMPLICATIONS Patients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.
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Affiliation(s)
- Kristina Nilsson
- Department of Internal Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Department of Internal Medicine, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
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7
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Kumar M, van Dellen D, Loughton H, Woywodt A. Time to press the reset button-can we use the COVID-19 pandemic to rethink the process of transplant assessment? Clin Kidney J 2021; 14:2137-2141. [PMID: 34603690 PMCID: PMC8344542 DOI: 10.1093/ckj/sfab118] [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: 06/16/2021] [Indexed: 11/24/2022] Open
Abstract
Coronavirus disease 2019 has taken a severe toll on the transplant community, with significant morbidity and mortality not just among transplant patients and those on the waiting list, but also among colleagues. It is therefore not surprising that clinicians in this field have viewed the events of the last 18 months as predominantly negative. As the pandemic is gradually ebbing away, we argue that this is also a unique opportunity to rethink transplant assessment. First, we have witnessed a step-change in the use of technology and virtual assessments. Another effect of the pandemic is that we have had to make do with what was available-which has often worked surprisingly well. Finally, we have learned to think the unthinkable: maybe things do not have to continue the way they have always been. As we emerge on the other side of the pandemic, we should rethink which parts of the transplant assessment process are necessary and evidence-based. We emphasize the need to involve patients in the redesign of pathways and we argue that the assessment process could be made more transparent to patients. We describe a possible roadmap towards transplant assessment pathways that are truly fit for the 21st century.
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Affiliation(s)
- Mukesh Kumar
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - David van Dellen
- Manchester Centre for Transplantation, Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | | | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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8
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Roberti J, Alonso JP, Blas L, May C. Kidney failure, status passage, and the transitional nature of living with the disease: A qualitative study in Argentina. Health (London) 2021; 27:458-475. [PMID: 34523374 DOI: 10.1177/13634593211046842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The span of kidney failure (KF) has been extended by advances in treatment. To elucidate the lived experiences of people with KF, we draw on Glaser and Strauss's theory of status passage. Semi-structured interviews were conducted with 50 patients with KF and 14 health professionals, from two healthcare facilities in Buenos Aires, Argentina. The theory informed on the temporal dimensions of people's passages and dimensions related to what actors know of this passage. We described the status passage as a sequence of transitions (starting dialysis, receiving a transplant, returning to dialysis) that have devastating effects on patient's roles, and are accompanied with fear and experience of wasting time. Temporal aspects were crucial and planning was useless; indeed, timing of statuses was uncertain. With a transplant, certain roles and capacities could be regained. Some patients were not aware of the chronic nature of the disease and the ultimate reversibility of the transplant. Control over the passage was minimal because of the unpredictable prognosis of the disease but patients employed strategies to regain it. Control was even more limited for people who migrated to receive a treatment; whose lives were completely altered. Status passage theory signaled the overwhelming impact of the passage on all aspects of people's lives, the uncertainty of the transitions, lack of control and awareness of essential aspects, and unexpected aspects of desirability, adding to our understanding of how people experience this disease and its treatments.
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Affiliation(s)
- Javier Roberti
- Institute for Clinical Effectiveness and Public Policy (IECS), Argentina.,CIESP/CONICET, Argentina
| | - Juan Pedro Alonso
- Institute for Clinical Effectiveness and Public Policy (IECS), Argentina.,Universidad de Buenos Aires, Argentina.,CONICET, Argentina
| | | | - Carl May
- London School of Hygiene and Tropical Medicine, UK
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9
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Gagliardi AR, Yip CYY, Irish J, Wright FC, Rubin B, Ross H, Green R, Abbey S, McAndrews MP, Stewart DE. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review. Health Expect 2021; 24:978-990. [PMID: 33769657 PMCID: PMC8235883 DOI: 10.1111/hex.13241] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Waiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences. OBJECTIVE To synthesize research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context. METHODS Using a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes. RESULTS We included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio-economic status, or with less-positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait-list position, prioritization criteria and anticipated procedure date. CONCLUSIONS Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context. PATIENT OR PUBLIC CONTRIBUTION Six patients and four caregivers waiting for COVID-19-delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.
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Affiliation(s)
- Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | | | - Jonathan Irish
- Surgical Oncology Program/Access to Care‐SurgeryOntario Health‐Cancer Care OntarioTorontoCanada
| | | | - Barry Rubin
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
| | - Heather Ross
- Ted Rogers Centre of Excellence in Heart FunctionUniversity Health NetworkTorontoCanada
| | - Robin Green
- Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
| | - Susan Abbey
- Medical Psychiatry & Psychosocial OncologyUniversity Health NetworkTorontoCanada
| | | | - Donna E. Stewart
- University Health Network Centre for Mental HealthUniversity of TorontoTorontoCanada
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Guha C, Viecelli AK, Wong G, Manera K, Tong A. Qualitative research methods and its application in nephrology. Nephrology (Carlton) 2021; 26:755-762. [PMID: 33951266 DOI: 10.1111/nep.13888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease is associated with an increased risk of mortality, comorbidities and life-threatening complications. Invasive treatments including dialysis or transplantation, complex pharmacological therapies, dietary restrictions and the ongoing need to attend follow-up appointments can place a substantial treatment burden on patients and carers and impair quality of life. This highlights the need for care that is responsive to the needs of patients and involves them in decision-making to achieve the most appropriate healthcare outcomes. Shared decision-making and collaborative approaches to care require a deep awareness of the lived experiences and goals of patients. Qualitative research methods can provide insights into patients' experiences, values and priorities and inform practice and policy by uncovering their preferences for care. Qualitative methods are increasingly being used in standalone projects or in mixed methods studies (complementing quantitative studies) to make valuable contributions to patient-centred research. Patient-centred care, collaborations between patient and care provider, and shared decision-making that integrates with the patient's goals are central to quality healthcare. The efficacy of qualitative research lies in its ability to elicit patients' perspectives, values, priorities and goals that underpin shared decision making and care. This article discusses examples of how qualitative research has informed practice and policy in nephrology, provides a summary of qualitative research methods and outlines a guide on how to appraise, interpret and apply qualitative data.
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Affiliation(s)
- Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrea K Viecelli
- Faculty of Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Vernooij RWM, Law W, Peters SAE, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, Bots ML. The probability of receiving a kidney transplantation in end-stage kidney disease patients who are treated with haemodiafiltration or haemodialysis: a pooled individual participant data from four randomised controlled trials. BMC Nephrol 2021; 22:70. [PMID: 33632160 PMCID: PMC7905891 DOI: 10.1186/s12882-021-02265-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. Methods Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. Results After a median follow-up of 2.5 years (Q1 to Q3: 1.9–3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86–1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92–1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. Conclusions Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.
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Affiliation(s)
- Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Way Law
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Wai-ping Law, Renal unit, Department of medicine, Queen Elizabeth Hospital, Hong Kong, PR China
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bernard Canaud
- Global Medical Office, Fresenius Medical Care Deutschland, Bad Homburg, Germany.,Montpellier University, School of Medicine, Montpellier, France
| | - Andrew Davenport
- University College London, Centre for Nephrology, Royal Free Hospital, London, UK
| | - Muriel P C Grooteman
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Francesco Locatelli
- Department of Nephrology, Alessandro Manzoni Hospital, past director, Lecco, Italy
| | | | - Marion Morena
- PhyMedExp, University of Montpellier, INSERM, CNRS, Biochemistry/Hormonology department, University Hospital Center of Montpellier, Montpellier, France
| | - Menso J Nubé
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ferran Torres
- Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Medical Statistics core facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Petre OA, Crăciun IC, Băban A. The experiences of living with a transplanted kidney from a deceased donor. J Ren Care 2020; 47:58-67. [PMID: 32964692 DOI: 10.1111/jorc.12349] [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: 02/16/2020] [Revised: 05/19/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kidney transplantation is considered an optimal treatment option for patients with end-stage kidney disease in terms of survival rate, quality of life and cost-effectiveness. However, posttransplant life involves many medical, psychological and social challenges for transplant recipients. Understanding individuals' challenges and needs after transplantation is a prerequisite for developing effective patient education and self-management programmes. OBJECTIVE To explore how individuals experience life with a transplanted kidney from a deceased donor. METHODS The purposive sample included eight kidney transplant recipients. In-depth semi-structured interviews were conducted and analysed using interpretative phenomenological analysis. FINDING Three main themes emerged from the data and each one presents a certain aspect of the posttransplant experience: an inner struggle to find a new normality (personal level), me and the others (relational level) and only between me, my donor and god (spiritual level). CONCLUSION The experience of receiving a kidney from a deceased donor represents a complex psychological challenge for recipients. The study is unique as it shows the spiritual dimension of the transplantation experience and how the recipients' views on transplantation and organ donation are shaped by their religious and cultural background, indicating the importance of a holistic nursing approach.
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Affiliation(s)
| | - Irina C Crăciun
- Babeș-Bolyai University, Cluj Napoca, Romania.,Freie Universität Berlin, Berlin, Germany
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Wood AF, Tocher J, Rodgers S. Delivering direct patient care in the haemodialysis unit: a focused ethnographic study of care delivery. J Res Nurs 2019; 24:712-725. [PMID: 34394597 DOI: 10.1177/1744987119883406] [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: 11/16/2022] Open
Abstract
Background Direct patient care is a term used within nursing and healthcare to help quantify and qualify care delivery. Direct patient care time is considered as a valuable measure by healthcare providers to indicate efficiency and to quantify nursing work, however little is understood of the patient experience and care delivery in haemodialysis settings. Aim The aim of this study was to gain an understanding of patients' and nursing staff perceptions and experiences of 'direct patient care' within one haemodialysis unit. Methods A focused ethnographic approach utilised participant observations, informal questioning, photographs and 27 semi-structured interviews of registered nurses, clinical support workers and patients. Observation notes and interviews were transcribed and thematically analysed. Results The key finding was the construction and reconceptualisation of care delivery in this setting. Care was identified to be delivered in two distinct ways, both of which allowed patients to feel cared for. 'Active care' where patients feel cared for when they are being dealt with directly by staff and 'Passive care' where patients feel cared for through staff availability and visibility. Conclusion Developing this understanding of patient care delivery in this specialism has highlighted some important aspects to the way care can be delivered which challenges current traditional understandings of direct patient care. Time spent with a patient is not the only important consideration to patient experience in haemodialysis. This understanding of passive care could improve care experiences in this setting.
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Affiliation(s)
- Alison F Wood
- Lecturer, School of Health and Social Care, Edinburgh Napier University, UK
| | - Jennifer Tocher
- Senior Lecturer, School of Health in Social Science, Department of Nursing Studies, University of Edinburgh, UK
| | - Sheila Rodgers
- Senior Lecturer, School of Health in Social Science, Department of Nursing Studies, University of Edinburgh, UK
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Goktas S, Camdeviren EK, Gezginci E, Kosucu SN. Social Support Perceptions and Hope Levels of Patients Waiting for Organ Transplantation. Transplant Proc 2019; 51:2245-2249. [DOI: 10.1016/j.transproceed.2019.01.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 10/26/2022]
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Jacobson J, Ju A, Baumgart A, Unruh M, O’Donoghue D, Obrador G, Craig JC, Dapueto JM, Dew MA, Germain M, Fluck R, Davison SN, Jassal SV, Manera K, Smith AC, Tong A. Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies. Am J Kidney Dis 2019; 74:179-192. [DOI: 10.1053/j.ajkd.2019.01.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/30/2019] [Indexed: 11/11/2022]
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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Sheikhalipour Z, Zamanzadeh V, Borimnejad L, Valizadeh L, Newton S, Shahbazi M, Zomorrodi A, Nazari M. The Effects of Religious and Cultural Beliefs on Muslim Transplant Candidates During the Pretransplant Waiting Period. Res Theory Nurs Pract 2018. [DOI: 10.1891/1541-6577.32.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background:Awaiting organ transplantation can be stressful, and pretransplant candidates’ religious and cultural beliefs can influence how they adapt to the stress. While little is known about the effect religious and cultural beliefs have on the pretransplant waiting period, virtually nothing is known regarding whether and how Shia Muslim patients’ religious and cultural beliefs facilitate more positive patient outcomes while they await transplantation. Therefore, it is important for nurses and other health care providers to understand transplant candidates’ experiences dealing with the stressors that present themselves during the pretransplant waiting period, especially how their religious and cultural beliefs affect their adaptation to the stressors.Aim:The purpose of this study was to explore the lived experience of Shia Muslim organ transplant candidates regarding how their religious and cultural beliefs affect their adaptation to the pretransplant waiting period.Sample:A purposeful sample of 11 Shia Muslim organ transplant candidates who were on an organ transplant waiting list in Iran (kidney,n= 4; heart,n= 4; liver,n= 3) was recruited.Method:A qualitative research design using the hermeneutical phenomenological approach was utilized in this study. In-depth unstructured interviews were conducted by one of the authors (ZS) in different locations across Iran.Results:Data analysis led to the development of six themes: “the misty road of organ transplantation,” “to accede to organ transplantation despite religious conflict,” “one step away from death,” “the master key of liberation,” “fear of the unknown,” and “reliance on God.”Nursing Implications:The findings of this study will help nurses understand the religious and cultural meaning associated with stressors experienced by Shia Muslim patients awaiting organ transplant. This information can assist nurses to develop plans of care that include patient-specific interventions that take into consideration the patients’ religious and cultural beliefs.Conclusion:Shia Muslim patients awaiting organ transplantation experience feelings that are often in conflict with their religious and cultural beliefs. However, the patients’ reliance on God during the pretransplant waiting period facilitated healthier attitudes regarding transplantation.
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Burns T, Fernandez R, Stephens M. The experience of waiting for a kidney transplant: A qualitative study. J Ren Care 2017. [DOI: 10.1111/jorc.12209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Ritin Fernandez
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
- Centre for Research in Nursing and Health; St George Hospital; Kogarah NSW Australia
| | - Moira Stephens
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
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Gross CR, Reilly-Spong M, Park T, Zhao R, Gurvich OV, Ibrahim HN. Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for patients awaiting kidney transplantation. Contemp Clin Trials 2017; 57:37-43. [PMID: 28342990 DOI: 10.1016/j.cct.2017.03.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with progressive kidney disease experience increasing physiologic and psychosocial stressors and declining health-related quality of life (HRQOL). METHODS We conducted a randomized, active-controlled, open-label trial to test whether a Mindfulness-based Stress Reduction (MBSR) program delivered in a novel workshop-teleconference format would reduce symptoms and improve HRQOL in patients awaiting kidney transplantation. Sixty-three transplant candidates were randomized to one of two arms: i) telephone-adapted MBSR (tMBSR, an 8-week program of meditation and yoga); or ii) a telephone-based support group (tSupport). Participants completed self-report questionnaires at baseline, post-intervention, and after 6-months. Anxiety, measured by the State-Trait Anxiety Inventory (STAI) post-intervention served as the primary outcome. Secondary outcomes included: depression, sleep quality, pain, fatigue, and HRQOL assessed by SF-12 Physical and Mental Component Summaries (PCS, MCS). RESULTS 55 patients (age 54±12yrs) attended their assigned program (tMBSR, n=27; tSupport, n=28). 49% of patients had elevated anxiety at baseline. Changes in anxiety were small and did not differ by treatment group post-intervention or at follow-up. However, tMBSR significantly improved mental HRQOL at follow-up: +6.2 points on the MCS - twice the minimum clinically important difference (95% CI: 1.66 to 10.8, P=0.01). A large percentage of tMBSR participants (≥90%) practiced mindfulness and reported it helpful for stress management. CONCLUSIONS Neither mindfulness training nor a support group resulted in clinically meaningful reductions in anxiety. In contrast, finding that tMBSR was more effective than tSupport for bolstering mental HRQOL during the wait for a kidney transplant is encouraging and warrants further investigation. ClinicalTrials.govNCT01254214.
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Affiliation(s)
- Cynthia R Gross
- University of Minnesota College of Pharmacy, United States; University of Minnesota School of Nursing, United States; University of Minnesota Center for Spirituality & Healing, United States.
| | | | - Taehwan Park
- St. Louis College of Pharmacy, Pharmacy Administration, United States
| | - Ruizhi Zhao
- University of Minnesota College of Pharmacy, United States
| | - Olga V Gurvich
- University of Minnesota School of Nursing, United States
| | - Hassan N Ibrahim
- University of Minnesota School of Medicine, Department of Nephrology, United States
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