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Iwai R, Shimazaki T, Hyry J, Kawakubo Y, Fukuhara M, Aono H, Ata S, Yokoyama T, Anzai D. Reliable Stenosis Detection Based on Thrill Waveform Analysis Using Non-Contact Arteriovenous Fistula Imaging. SENSORS (BASEL, SWITZERLAND) 2024; 24:5068. [PMID: 39124115 PMCID: PMC11314651 DOI: 10.3390/s24155068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Hemodialysis therapy is an extracorporeal circulation treatment that serves as a substitute for renal function. In Japan, patients receive this efficient four-hour treatment, three times per week, allowing them to maintain a social life nearly equivalent to that of healthy individuals. Before the treatment, two punctures are performed to establish extracorporeal circulation, and a high blood flow rate is essential to ensure efficient therapy. Specialized blood vessels created through arteriovenous fistula (AVF) surgery are utilized to achieve high blood flow rates. Although the AVF allows safe and efficient dialysis treatment, AVF stenosis leads to a serious problem in dialysis. To early detect this abnormal blood flow, auscultation and palpation methods are widely used in hospitals. However, these methods can only provide qualitative judgment of the AVF condition, so the results cannot be shared among other doctors and staff. Additionally, since the conventional methods require contact with the skin, some issues require consideration regarding infection and low reproducibility. In our previous study, we proposed an alternative method for auscultation using non-contact optical imaging technology. This study aims to construct a reliable AVF stenosis detection method using Thrill waveform analysis based on the developed non-contact device to solve the problem with the contact palpation method. This paper demonstrates the performance validation of the non-contact imaging in the normal AVF group (206 total data, 75 patients, mean age: 69.1 years) and in the treatable stenosis group (107 total data, 17 patients, mean age: 70.1 years). The experimental results of the Mann-Whitney U test showed a significant difference (p=0.0002) between the normal and abnormal groups, which indicated the effectiveness of the proposed method as a new possible alternative to palpation.
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Affiliation(s)
- Rumi Iwai
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka 819-0395, Japan;
| | - Takunori Shimazaki
- Department of Clinical Engineering, Faculty of Health Care, Jikei University of Health Care Sciences, Osaka 532-0003, Japan; (T.S.); (Y.K.)
- Graduate School of Engineering, Osaka Metropolitan University, Osaka 558-8585, Japan;
| | - Jaakko Hyry
- Graduate School of Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan;
| | - Yoshifumi Kawakubo
- Department of Clinical Engineering, Faculty of Health Care, Jikei University of Health Care Sciences, Osaka 532-0003, Japan; (T.S.); (Y.K.)
| | - Masashi Fukuhara
- Department of Clinical Engineering, Shikoku Central Hospital of the Mutual Aid Association of Public School Teachers, Ehime 799-0193, Japan
| | - Hiroki Aono
- Department of Clinical Engineering, Shikoku Central Hospital of the Mutual Aid Association of Public School Teachers, Ehime 799-0193, Japan
| | - Shingo Ata
- Graduate School of Engineering, Osaka Metropolitan University, Osaka 558-8585, Japan;
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Daisuke Anzai
- Graduate School of Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan;
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Brathwaite S, Alabi O, Simpson L, Massarweh N. Exploring Health Literacy and Vascular Access Decision Making: A Scoping Review. J Clin Med 2024; 13:3734. [PMID: 38999300 PMCID: PMC11242509 DOI: 10.3390/jcm13133734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type of vascular access for hemodialysis, in 2021, 85.4% of patients initiated dialysis with a CVC. While the reasons for this evidence-practice gap are unclear, health literacy and patient disease-specific knowledge may play an important role. Importantly, 25% of patients with CKD have limited health literacy. While there is an abundance of research regarding the presence of poor health literacy, poor kidney disease-specific knowledge, and their association with health outcomes in patients with CKD, there is currently a paucity of data about the relationship between health literacy, vascular access-specific knowledge, and vascular access outcomes. The aim of this narrative review is to describe the relationship between health literacy, disease-specific knowledge, and vascular access in patients with CKD. A better understanding of health literacy in this population will help inform the development of strategies to assess patient vascular access-specific knowledge and aid in vascular access decision making.
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Affiliation(s)
- Shayna Brathwaite
- Surgical and Perioperative Care, Atlanta VA Healthcare System, Decatur, GA 30033, USA; (O.A.); (N.M.)
- Division of Vascular Surgery, Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Olamide Alabi
- Surgical and Perioperative Care, Atlanta VA Healthcare System, Decatur, GA 30033, USA; (O.A.); (N.M.)
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Lynne Simpson
- Information Services, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Nader Massarweh
- Surgical and Perioperative Care, Atlanta VA Healthcare System, Decatur, GA 30033, USA; (O.A.); (N.M.)
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, USA
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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Liu Z, Hitchcock DB, Singapogu RB. Cannulation Skill Assessment Using Functional Data Analysis. IEEE J Biomed Health Inform 2023; 27:4512-4523. [PMID: 37310836 PMCID: PMC10519736 DOI: 10.1109/jbhi.2023.3283188] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVE A clinician's operative skill-the ability to safely and effectively perform a procedure-directly impacts patient outcomes and well-being. Therefore, it is necessary to accurately assess skill progression during medical training as well as develop methods to most efficiently train healthcare professionals. METHODS In this study, we explore whether time-series needle angle data recorded during cannulation on a simulator can be analyzed using functional data analysis methods to (1) identify skilled versus unskilled performance and (2) relate angle profiles to degree of success of the procedure. RESULTS Our methods successfully differentiated between types of needle angle profiles. In addition, the identified profile types were associated with degrees of skilled and unskilled behavior of subjects. Furthermore, the types of variability in the dataset were analyzed, providing particular insight into the overall range of needle angles used as well as the rate of change of angle as cannulation progressed in time. Finally, cannulation angle profiles also demonstrated an observable correlation with degree of cannulation success, a metric that is closely related to clinical outcome. CONCLUSION In summary, the methods presented here enable rich assessment of clinical skill since the functional (i.e., dynamic) nature of the data is duly considered.
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Liu Z, Bible J, Petersen L, Roy-Chaudhury P, Geissler J, Brouwer-Maier D, Singapogu R. Measuring Cannulation Skills for Hemodialysis: Objective Versus Subjective Assessment. Front Med (Lausanne) 2021; 8:777186. [PMID: 34917637 PMCID: PMC8669158 DOI: 10.3389/fmed.2021.777186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Lack of cannulation skill during hemodialysis treatments results in poor clinical outcomes due to infiltration and other cannulation-related trauma. Unfortunately, training of patient care technicians and nurses, specifically on the "technical" aspects of cannulation, has traditionally not received much attention. Simulators have been successfully deployed in many medical specialties for assessment and training of clinical skills. However, simulators have not been as widely used in nursing, especially in the context of training clinical personnel in the dialysis unit. We designed a state-of-the-art simulator for quantifying skill for hemodialysis cannulation. In this study, 52 nurses and patient care technicians with varying levels of clinical experience performed 16 cannulations on the simulator with different fistula properties. We formulated a composite metric for objectively measuring overall success of cannulation and compared this metric with subjective assessment by experts. In addition, we examined if years of clinical experience correlated with objective and subjective scores for cannulation skill. Results indicated that, while subjective and objective metrics generally correlated with each other, the objective metric was more precise and better suited for quantifying cannulation skill. Further, the simulator-based objective metric provides several advantages over subjective ratings, including providing fine-grained assessment of skill, consistency in measurement unaffected by subjective biases, and basing assessment on a more complete evaluation of performance. Years of clinical experience, however, demonstrated little correlation with either method of skill assessment. The methods presented for cannulation skill assessment in this study, if widely applied, could result in improved cannulation skill among our PCTs and nurses, which could positively impact patient outcomes in a tangible way.
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Affiliation(s)
- Zhanhe Liu
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Joe Bible
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, United States
| | - Lydia Petersen
- Department of Bioengineering, Clemson University, Clemson, SC, United States
| | - Prabir Roy-Chaudhury
- UNC Kidney Center, University of North Carolina, Chapel Hill, NC, United States.,(Bill Hefner) VA Medical Center, Salisbury, NC, United States
| | - Judy Geissler
- Williams S Middleton Memorial Veterans Hospital, Madison, WI, United States
| | | | - Ravikiran Singapogu
- Department of Bioengineering, Clemson University, Clemson, SC, United States
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Singapogu R, Chowdhury A, Roy-Chaudhury P, Brouwer-Maier D. Simulator-based hemodialysis cannulation skills training: a new horizon? Clin Kidney J 2021; 14:465-470. [PMID: 33623670 PMCID: PMC7886575 DOI: 10.1093/ckj/sfaa206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022] Open
Abstract
In accordance with the recently released Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, there is a significant need for focused efforts on improving hemodialysis cannulation outcomes. Toward this, structured and meaningful training of our clinical personnel who cannulate in dialysis clinics is a priority. With the availability of advanced sensors and computing methods, simulators could be indispensable tools for standardized skills assessment and training. In this article we present ways in which sensor data could be used to quantify cannulation skill. As with many other medical specialties, implementation of simulator-based training holds the promise of much-needed improvement in end-stage kidney disease patient outcomes.
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Affiliation(s)
| | - Aniqa Chowdhury
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, NC.; and, WG (Bill) Hefner VA Medical Center, Salisbury, NC, USA
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Sousa CN, Paquete ARC, Teles P, Pinto CMCB, Dias VFF, Ribeiro OMPL, Manzini CSS, Nicole AG, Souza LH, Ozen N. Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis Patients. Clin Nurs Res 2020; 30:866-874. [PMID: 33269608 DOI: 10.1177/1054773820974834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to assess the effectiveness of a structured intervention on the frequency of self-care behaviors with arteriovenous fistula (AVF) by patients on hemodialysis. This is a quasi-experimental study with pre- and post-measurements. Participants were assigned to an intervention group (IG) (n = 48) or to a control group (CG) (n = 41). IG patients were subject to a structured intervention on self-care with AVF (SISC-AVF) consisting of both a theoretical and a practical part. After SISC-AVF application, patients in the IG showed better overall self-care behaviors with AVF than patients in the CG (79.2% and 91.4%, respectively, p < .001) as well as better self-care concerning both the management of signs and symptoms (90.1% and 94.4% respectively, p = .004) and the prevention of complications (72.7% and 89.5%, respectively, p < .001). The study results suggest that the SISC-AVF had positive effects on patients in the IG.
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Affiliation(s)
- Clemente Neves Sousa
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | | | - Paulo Teles
- School of Economics, University of Porto and LIAAD-INESC Porto LA, Porto, Portugal
| | - Cristina Maria Correia Barroso Pinto
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Vanessa Filipa Ferreira Dias
- Institute of Health Sciences, Católica University, Lisbon, Portugal.,Unidade de Saúde Familiar St. André de Canidelo, Vila Nova de Gaia, Porto, Portugal
| | - Olga Maria Pimenta Lopes Ribeiro
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | | | | | - Lara Helk Souza
- Faculdade Medicina São José Rio Preto (FAMERP), São josé do Rio Preto, Brazil
| | - Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Vachharajani TJ, Nakhoul G, Taliercio JJ. Long-Term AVF Patency - Can we do better? ACTA ACUST UNITED AC 2019; 41:307-309. [PMID: 31268114 PMCID: PMC6788835 DOI: 10.1590/2175-8239-jbn-2019-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Tushar J Vachharajani
- Cleveland Clinic Foundation, Cleveland, Glickman Urological & Kidney Institute, Department of Nephrology & Hypertension, Cleveland, OH, USA
| | - Georges Nakhoul
- Cleveland Clinic Foundation, Cleveland, Glickman Urological & Kidney Institute, Department of Nephrology & Hypertension, Cleveland, OH, USA
| | - Jonathan J Taliercio
- Cleveland Clinic Foundation, Cleveland, Glickman Urological & Kidney Institute, Department of Nephrology & Hypertension, Cleveland, OH, USA
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Vatazin AV, Zulkarnaev AB, Fominykh NM, Kardanakhishvili ZB, Strugailo EV. The creation and maintenance of vascular access for chronic hemodialysis in the Moscow region: a five-year experience of a regional center. ACTA ACUST UNITED AC 2019. [DOI: 10.15825/1995-1191-2018-4-44-53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aim:to analyze the results of the regional center for the creation and maintenance of vascular access for hemodialysis.Materials and methods.We performed a retrospective analysis. In five years (2012–2016) we performed 3,837 different operations on vascular access (VA) in 1,862 patients.Results.There is a strong dependence of type VA and the cause of CKD 5D. At the time of the HD start, the proportion of arteriovenous fistula (AVF), synthetic vascular graft (SVG) and central venous catheter (CVC) was 73.7, 0.3 and 26% for glomerulonephritis; 58.4, 0.4 and 41% for pyelonephritis; 53, 1 and 26% for diabetes mellitus; 32, 8 and 60% for polycystic disease and 33, 2 and 65% for systemic processes, respectively. After one year on HD the shares of AVF, SVG and CVC were 89, 2 and 9% for glomerulonephritis; 76, 6 and 18% of pyelonephritis; 70, 5 and 25% for diabetes mellitus; 68, 10 and 22% for polycystic disease and 53, 5 and 42% for systemic processes, respectively. In a case of start of HD via AVF, five years survival was 61% [95% CI 51.8; 71.9]; in a case of start HD via CVC with followed by conversion to AVF – 53.9% [95% CI 42.5; 67]; in a case of CVC remained the only access – 31.6% [21.4; 41.4]. Non-maturation of AVF was observed in 5.9% of new AVF (the risk increased in a case of diabetes mellitus), early thrombosis (before the first use of AVF) was observed in 12.7% of new AVF (the risk increased with diabetes, polycystic and systemic diseases). Creation of AVF a week before the start of HD or 1–2 weeks later significantly increased the risk of thrombosis. Primary patency in a year, three and five years was 77.2% (95% CI 71.7; 81.7); 48% (95% CI 41.6, 54.1); 34.1% (95% CI 27.8, 40.5) respectively; secondary patency – 87% [95% CI 83.7; 89.7]; 74.4% [95% CI 70.3; 78,12]; 60.9% [95% CI 56.4; 65.1] respectively. The use of temporary CVC is associated with a three-fold increase of the risk of infection compared with permanent CVC: IRR 3,31 (2,46; 4,43), p < 0,0001.Conclusion.A more detailed analysis is required to identify risk factors for complications of vascular access and to optimize approaches to its creation and maintenance.
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Affiliation(s)
- A. V. Vatazin
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
| | - A. B. Zulkarnaev
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
| | - N. M. Fominykh
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
| | | | - E. V. Strugailo
- M.F. Vladimirsky Moscow Regional Clinical and Research Institute
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Harhay MN, Xie D, Zhang X, Hsu CY, Vittinghoff E, Go AS, Sozio SM, Blumenthal J, Seliger S, Chen J, Deo R, Dobre M, Akkina S, Reese PP, Lash JP, Yaffe K, Kurella Tamura M. Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2018; 72:499-508. [PMID: 29728316 PMCID: PMC6153064 DOI: 10.1053/j.ajkd.2018.02.361] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/08/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advanced chronic kidney disease is associated with elevated risk for cognitive impairment. However, it is not known whether and how cognitive impairment is associated with planning and preparation for end-stage renal disease. STUDY DESIGN Retrospective observational study. SETTING & PARTICIPANTS 630 adults participating in the CRIC (Chronic Renal Insufficiency Cohort) Study who had cognitive assessments in late-stage CKD, defined as estimated glome-rular filtration rate ≤ 20mL/min/1.73m2, and subsequently initiated maintenance dialysis therapy. PREDICTOR Predialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination lower than previously derived age-based threshold scores. Covariates included age, race/ethnicity, educational attainment, comorbid conditions, and health literacy. OUTCOMES Peritoneal dialysis (PD) as first dialysis modality, preemptive permanent access placement, venous catheter avoidance at dialysis therapy initiation, and preemptive wait-listing for a kidney transplant. MEASUREMENTS Multivariable-adjusted logistic regression. RESULTS Predialysis cognitive impairment was present in 117 (19%) participants. PD was the first dialysis modality among 16% of participants (n=100), 75% had preemptive access placed (n=473), 45% avoided using a venous catheter at dialysis therapy initiation (n=279), and 20% were preemptively wait-listed (n=126). Predialysis cognitive impairment was independently associated with 78% lower odds of PD as the first dialysis modality (adjusted OR [aOR], 0.22; 95% CI, 0.06-0.74; P=0.02) and 42% lower odds of venous catheter avoidance at dialysis therapy initiation (aOR, 0.58; 95% CI, 0.34-0.98; P=0.04). Predialysis cognitive impairment was not independently associated with preemptive permanent access placement or wait-listing. LIMITATIONS Potential unmeasured confounders; single measure of cognitive function. CONCLUSIONS Predialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis therapy initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis therapy.
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Affiliation(s)
- Meera N Harhay
- Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA.
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Eric Vittinghoff
- Division of Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Stephen M Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Jacob Blumenthal
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - Jing Chen
- Division of Nephrology, Department of Medicine, Tulane School of Medicine, New Orleans, LA
| | - Rajat Deo
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Sanjeev Akkina
- Department of Medicine, Loyola University Medical Center, Maywood, IL
| | - Peter P Reese
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, CA; Department of Neurology, University of California, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, VA Palo Alto, Palo Alto, CA; Stanford University School of Medicine, Palo Alto, CA
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Campbell-Crofts S, Stewart G. How perceived feelings of "wellness" influence the decision-making of people with predialysis chronic kidney disease. J Clin Nurs 2018; 27:1561-1571. [PMID: 29240277 DOI: 10.1111/jocn.14220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To identify the subjective meanings attached to decisions made by people living with chronic kidney disease as they consider their transition to renal replacement therapy. BACKGROUND Within the challenging world of chronic illness, people draw upon their temporal life experiences to help them make the best or most balanced primary healthcare decisions. Understanding the risks and benefits associated with these decisions has been an area of intense interest in health research. DESIGN An exploratory qualitative descriptive design. METHOD A convenience sample of twelve people, at stages 3B to 5 of chronic kidney disease, attending two predialysis renal clinics in Sydney, Australia, consented to be interviewed. The semi-structured interviews centred on their decision-making experiences as they considered their transition to renal replacement therapy. RESULTS Three themes emerged from participant narratives which have been framed into the following questions: (i) Do I need renal replacement therapy? (ii) What is the "right" renal replacement therapy for me? and (iii) When should I start renal replacement therapy? Decisions about the transition to renal replacement therapy were impacted upon by the participants' perceived feelings of wellness and the belief that renal replacement therapy would not be needed at any time in the foreseeable future. CONCLUSION This study highlights the importance of optimising person-centred care and raises important issues for the education and management of people with chronic kidney disease in the predialysis stages of the illness. RELEVANCE TO CLINICAL PRACTICE In order to facilitate the transition to renal replacement therapy, renal clinicians have a responsibility to more fully understand the patient journey during the predialysis stages of chronic kidney disease. A clearer understanding of patients' perceptions and decision-making experiences creates a space for mutual understanding. This is essential for the future development and implementation of collaborative, person-centred educational strategies and long-term renal healthcare outcomes.
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Affiliation(s)
| | - Glenn Stewart
- Concord Repatriation General Hospital, Concord, NSW, Australia
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Moist LM, Lok CE. Incident Dialysis Access in Patients With End-Stage Kidney Disease: What Needs to Be Improved. Semin Nephrol 2017; 37:151-158. [DOI: 10.1016/j.semnephrol.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Sousa CN, Marujo P, Teles P, Lira MN, Novais MELM. Self-Care on Hemodialysis: Behaviors With the Arteriovenous Fistula. Ther Apher Dial 2017; 21:195-199. [DOI: 10.1111/1744-9987.12522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Clemente Neves Sousa
- Nursing School of Porto; Porto Portugal
- CINTESIS - Center for Health Technology and Services Research Faculty of Medicine; Porto University; Porto Portugal
| | | | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA; Porto University; Porto Portugal
| | - Marta Nunes Lira
- SOS Renal Service, Olinda Pernambuco, Brasil and Nursing Master student; Federal University of Pernambuco; Recife Brazil
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13
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Moist LM, Al-Jaishi AA. Preparation of the Dialysis Access in Stages 4 and 5 CKD. Adv Chronic Kidney Dis 2016; 23:270-5. [PMID: 27324681 DOI: 10.1053/j.ackd.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/16/2015] [Accepted: 04/01/2016] [Indexed: 11/11/2022]
Abstract
Patients with Stages 4 and 5 CKD are optimally managed within a multidisciplinary care setting. This provides an opportunity to create a "patient centered" approach to renal replacement modality options and conservative care. The care team engages with the patient and caregivers to assist with the understanding of their health status, modality and vascular access selection, and overall living with the comorbidity of chronic illness. A systematic approach to provision of education, modality, and access selection, are in part, driven by the patient's expected survival and need for dialysis, the risks and benefits with different modalities, and access and adaptation to their preferences and home situations. Dialysis access education should be included in all education programs so that patients can consider risks and benefits of all modalities. Decision support interventions have been effective in reducing decisional conflict and informed values-based decision-making. For both hemodialysis and peritoneal dialysis, timing of the surgical referral and access creation should be individualized based on the rate of CKD progression, risk of complications, and ease of access to surgical services. The health care team should support the patients' decision balancing risks and benefits, as well as their lifestyle, values, beliefs, and preferences.
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Lomonte C, Basile C. Preoperative assessment and planning of haemodialysis vascular access. Clin Kidney J 2015; 8:278-81. [PMID: 26034588 PMCID: PMC4440469 DOI: 10.1093/ckj/sfv022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/19/2015] [Indexed: 11/12/2022] Open
Abstract
Effective haemodialysis (HD) requires a reliable vascular access (VA). Clinical practice guidelines strongly recommend the arteriovenous fistula (AVF) as the preferred VA in HD patients. The creation of an AVF should be promoted in all eligible patients who choose HD, as it improves outcomes and reduces costs when compared with central venous catheters. Fistula eligibility is a ‘work in progress’. Three steps in order to increase the pool of eligible patients can be individualized: (i) process of care, which includes three fundamental items: the VA team, early VA education and timely VA surgery referral; (ii) preoperative evaluation; (iii) surgical strategy. Nephrologists should be able to play a leading and coordinating role of the VA team. They should design a plan that identifies a sequence of options that can be used to provide adequate renal replacement therapy throughout the life span of every end-stage renal disease patient. The main points of this strategy are (i) early vascular education, in which a ‘save the vein program’ should always be implemented; (ii) timely VA surgery referral and preoperative evaluation: careful examination of arterial and venous beds is mandatory before VA placement; physical examination in addition to colour Doppler ultrasound mapping improves AVF outcomes; (iii) surgical strategy: a successful VA strategy must take into account vascular anatomy, clinical factors and prognosis.
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Affiliation(s)
- Carlo Lomonte
- Division of Nephrology , Miulli General Hospital, Acquaviva delle Fonti , Italy
| | - Carlo Basile
- Division of Nephrology , Miulli General Hospital, Acquaviva delle Fonti , Italy
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15
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Affiliation(s)
- Tushar J. Vachharajani
- Department of Nephrology; W. G. (Bill) Hefner Veterans Affairs Medical Center; Salisbury North Carolina
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16
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Schoch M, Bennett P, Fiolet R, Kent B, Au C. Renal access coordinators’ impact on hemodialysis patient outcomes and associated service delivery: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Abstract
Effective hemodialysis requires a reliable vascular access. Clinical practice guidelines strongly recommend the fistula as the preferred option followed by arteriovenous (AV) grafts, with central venous catheters being least preferred. Recently, there has been a growing awareness of the limitations of the fistula, its high rate of primary failure and that a fistula may not be appropriate for all patients initiating or on hemodialysis. However, determinates for fistula eligibility have not been clearly defined. The creation and use of a fistula requires the complex integration of patient, biological, and surgical factors, none of which can be easily predicted or planned. There have been several successful initiatives over the last decade addressing patient suitability for AV access, but none have validated defined criteria for fistula eligibility. We discuss these initiatives by addressing: 1) process of care, 2) radiological and nonradiological tests and procedures, and 3) alternative surgical approaches. Careful clinical judgment, appropriate vascular access assessment and placement, and an individualized approach to the risks and benefits will optimize patient health outcomes while minimizing prolonged catheter dependence among hemodialysis patients.
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Affiliation(s)
- Ahmed A Al-Jaishi
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Kidney, Dialysis, Transplantation Program, Institute for Clinical Evaluative Sciences (ICES-KDT), London, Ontario, Canada
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18
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Pierratos A. Patient education in CKD and ESRD: merging the left and right brain. Semin Dial 2013; 26:135-7. [PMID: 23520986 DOI: 10.1111/sdi.12081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andreas Pierratos
- Humber River Regional Hospital, University of Toronto, Ontario Renal Network, Toronto, Ontario, Canada.
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19
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Silva TNV, de Marchi D, Mendes ML, Barretti P, Ponce D. Approach to prophylactic measures for central venous catheter-related infections in hemodialysis: A critical review. Hemodial Int 2013; 18:15-23. [DOI: 10.1111/hdi.12071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tricya N. V. Silva
- Botucatu School of Medicine; University of São Paulo State-UNESP; Botucatu São Paulo Brazil
| | - Daniel de Marchi
- Botucatu School of Medicine; University of São Paulo State-UNESP; Botucatu São Paulo Brazil
| | - Marcela L. Mendes
- Botucatu School of Medicine; University of São Paulo State-UNESP; Botucatu São Paulo Brazil
| | - Pasqual Barretti
- Botucatu School of Medicine; University of São Paulo State-UNESP; Botucatu São Paulo Brazil
| | - Daniela Ponce
- Botucatu School of Medicine; University of São Paulo State-UNESP; Botucatu São Paulo Brazil
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20
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O'Hare AM. Vascular access for hemodialysis in older adults: a "patient first" approach. J Am Soc Nephrol 2013; 24:1187-90. [PMID: 23813217 DOI: 10.1681/asn.2013050507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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