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Lo CT, Sheshadri A, Edmonson L, Nair D. Patient-Reported Outcomes to Achieve Person-Centered Care for Aging People With Kidney Disease. Semin Nephrol 2024:151548. [PMID: 39181804 DOI: 10.1016/j.semnephrol.2024.151548] [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: 08/27/2024]
Abstract
Person-centered care is a system of care delivery that supports effective patient-clinician communication and empowers patients to partner with their clinical providers to develop goal-concordant treatment plans. Models of person-centered care often involve the implementation of patient-reported outcomes (PROs) to measure patients' symptoms and quality of life as they navigate complex chronic health conditions. Models of person-centered care have been particularly effective in improving the quality of care delivery for older adults as well as younger adults with aging-associated conditions such as physical function decline. Though PROs have been developed and validated in kidney disease, they are not routinely implemented in clinical practice. Most individuals with kidney disease are 65 and older, but many younger individuals with kidney disease also experience aging-associated conditions earlier than in the general population. Thus, PROs represent an important tool for achieving person-centered care in groups with kidney disease who are the most vulnerable to adverse health outcomes and excess health care utilization. In this article, we aim to move toward more routine implementation of PROs in kidney care for aging adults. To identify the most clinically relevant PROs for this group and understand the ideal mode and context in which to implement PROs, we will (1) provide an evidence-based summary of PROs with the greatest prognostic significance in the general population and in kidney disease, including those specific to older adults; (2) describe barriers to the implementation of PROs in kidney care with a special focus on the needs of older adults and younger adults with aging-associated conditions; and (3) conclude with our evidence-based recommendations for the content, time, and context in which PROs should be implemented to achieve person-centered kidney care for aging adults. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.
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Affiliation(s)
- Claire T Lo
- Division of Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Anoop Sheshadri
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
| | - Larry Edmonson
- Person With Chronic Kidney Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Tennessee Valley Veterans Affairs Health System, Nashville, TN.
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Lambert K, Ryan M, Flanagan J, Broinowski G, Nicdao M, Stanford J, Chau K. Dietary Patterns, Dietary Adequacy and Nutrient Intake in Adults Commencing Peritoneal Dialysis: Outcomes from a Longitudinal Cohort Study. Nutrients 2024; 16:663. [PMID: 38474791 DOI: 10.3390/nu16050663] [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: 01/10/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: Optimal dietary intake is integral to good health in people receiving peritoneal dialysis (PD). We investigated how dietary patterns, dietary adequacy and nutrient intake may change over time in people commencing PD. (2) Methods: Participants were attending the PD training unit for the commencement of peritoneal dialysis, aged ≥18 years and willing to complete food records. Misreporters were excluded from the analysis. Dietary intake was compared at PD commencement and at 12 months. Intake was also compared to reference standards. Dietary patterns were derived using principal component analysis. (3) Results: There were no significant changes between baseline and 12 months for grains, fruit, vegetables and meat. Dairy and added sugar intake was significantly lower (p = 0.01). The intake of energy and protein was adequate and did not change. There was a significant reduction in dietary phosphorus and calcium, and increased vitamin C intake. Three dietary patterns were identified: the 'Bread and Cereal' pattern; 'Milk and Potatoes' pattern; and the 'Semi Vegetarian' pattern. (4) Conclusions: In this longitudinal cohort study, the diet quality was suboptimal and there were limited changes in intake after the commencement of PD. Further exploration of how dietary patterns may impact outcomes and quality of life is warranted.
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Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Michele Ryan
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Jade Flanagan
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Georgie Broinowski
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Maryann Nicdao
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Jordan Stanford
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Katrina Chau
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
- Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia
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Wang FY, Cui Z, Su CY, Wang T, Tang W. Prognostic implications of predialysis patients' symptoms in peritoneal dialysis patients. Ren Fail 2021; 43:216-222. [PMID: 33478321 PMCID: PMC7833081 DOI: 10.1080/0886022x.2021.1871920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/26/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As kidney disease progresses, patients often experience a variety of symptoms. There are very few studies reporting spectrum of predialysis patients' symptoms in peritoneal dialysis (PD) patients. Furthermore, the clinical significance of predialysis patients' symptoms for PD patients' prognosis remains unknown. METHODS In this retrospective cohort study, patients who started PD during 1 January 2006 to 31 January 2018 were included. Patients' predialysis symptoms and clinical parameters were obtained. Both the short- and long-term patients' outcome were investigated by Cox regression and Kaplan-Meier's survival analysis to identify the relationship between clinical symptoms and patients' mortality on PD. RESULTS A total of 898 incident PD patients were included. The anorexia (58%) was the most common predialysis symptom in the present cohort, followed by insomnia (32.7%), fatigue (27.6%), syndromes of heart failure (27.6%), and nausea (20.5%). The only symptom significantly associated with both six-months and 12-months mortality on PD was nausea (HR 2.359, 95% CI 1.377-4.040, p=.002 and HR 1.791, 95% CI 1.176-2.729, p=.007, respectively). But in the long-term, anorexia (HR 1.392, 95% CI 1.070-1.811, p=.014) was the only symptom significantly associated with patient's all-cause mortality after adjusting for other confounding factors. CONCLUSIONS Our study demonstrated that nausea and anorexia were the most important predialysis symptoms, which was associated with patients' short- and long-term mortality on PD treatment, respectively. The results indicated that predialysis evaluation and management of symptoms of nausea and anorexia may be a possible way to improve patients' outcome on PD.
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Affiliation(s)
- Fang-Yu Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Zhuan Cui
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Chun-yan Su
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Tao Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Wen Tang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
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Boonyakrai C, Kanjanabuch T, Puapatanakul P, Halue G, Johnson DW, Lorvinitnun P, Tangjittrong K, Kittiskulnam P, Pongpirul K, Bieber B, Tungsanga K. Association between self-reported appetite and clinical outcomes of peritoneal dialysis patients: Findings from a low middle-income country. Nephrology (Carlton) 2021; 26:454-462. [PMID: 33550668 DOI: 10.1111/nep.13859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
AIM Patient-reported outcome measures (PROM) has gained international recognition as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand the associations between patient-reported appetite and clinical outcomes. METHODS In the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), 690 of 848 randomly selected PD patients from 22 facilities reported their appetite by using the short form (three items) of the Appetite and Diet Assessment Tool (ADAT), between 2016 and 2018. In this questionnaire, the patients rated their appetite as well as a change in appetite over time. Cox proportional hazards model regression was used to estimating associations between self-reported appetite and clinical outcomes, including mortality, haemodialysis (HD) transfer and peritonitis. RESULTS Half of the PD patients reported a good appetite, whereas 34% and 16% reported fair and poor appetites, respectively. Poor appetite was more prevalent among female, diabetic, congestive heart failure, older age and patients who had worse nutritional indicators, including lower time-averaged serum albumin and serum creatinine concentrations, as well as a higher proportions of hypokalaemia and severe hypoalbuminemia (serum albumin <3 g/dl). After adjusting for age, sex, comorbidities, and PD vintage, poor appetite was associated with increased risks of peritonitis (adjusted hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.14-2.62), HD transfer (adjusted HR 2.25, 95% CI 1.24-4.10) and all-cause mortality (adjusted HR 1.60, 95% CI 1.08-2.39) compared to patients with good appetite. CONCLUSION Patient-reported poor appetite was independently associated with higher risks of peritonitis, HD transfer and all-cause mortality. This warrants further investigation to identify effective interventions.
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Affiliation(s)
- Chanchana Boonyakrai
- Department of Medicine, Taksin Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Guttiga Halue
- Department of Medicine, Phayao Hospital, Phayao, Thailand
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Kittisak Tangjittrong
- Division of Nephrology, Department of Internal Medicine, Pranangklao Hospital, Nonthaburi, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
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Melo TL, Meireles MS, Kamimura MA, Cuppari L. Concurrent validity of an appetite questionnaire in peritoneal dialysis. Perit Dial Int 2020; 40:41-46. [PMID: 32063151 DOI: 10.1177/0896860819879878] [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] Open
Abstract
BACKGROUND Decreased appetite is a symptom often found in chronic kidney disease. Poor appetite may negatively affect food intake, what in long-term may contribute to the development of protein-energy malnutrition. METHODS An Appetite and Food Satisfaction Questionnaire (AFSQ) was developed consisting of a question that assesses the level of appetite through a facial hedonic scale and five other questions adapted from the Buckner and Dwyer tool that assess some aspects related to food satisfaction. Each question received an arbitrary score of 0 to 3. The sum of the scores ranged from 0, the best, to 18, the worst condition. Nutritional status was assessed through seven-point SGA, bioelectrical impedance, anthropometry, and handgrip strength (HGS). RESULTS Eighty-four patients on peritoneal dialysis (PD; 58.3% women, mean age 54.7 ± 14.2 years, and body mass index (BMI) of 26.0 ± 4.8 kg/m2) were evaluated. Median AFSQ score was 4.0 (1.0-6.8; median and IQ). Patients were divided into tertiles according to the AFSQ score. Comparing the third tertile (score ≥ 6) with the first tertile (score < 2), the prevalence of malnutrition was greater (32.1% vs. 6.7%, respectively, p = 0.005), HGS adequacy was lower (74.6% vs. 87.3%, p = 0.001), and body cell mass index (5.7% vs. 7.4%, p = 0.001) and lean BMI were lower (11% vs. 13.4%, p = 0.001) in the third tertile. CONCLUSION Poor appetite and food satisfaction determined by the questionnaire was related to worse nutritional markers, indicating AFSQ as a valid easy-to-use tool to be applied as an initial screening to identify PD patients with potential risk of malnutrition.
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Affiliation(s)
- Thalita L Melo
- Nutrition Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marion S Meireles
- Nutrition Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria A Kamimura
- Nutrition Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lilian Cuppari
- Nutrition Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil.,Division of Nephrology, Universidade Federal de São Paulo and Oswaldo Ramos Foundation - Hrim, São Paulo, Brazil
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Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial 2018; 32:452-462. [PMID: 30575128 DOI: 10.1111/sdi.12770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.
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Affiliation(s)
- Rute Aguiar
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Ming Pei
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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Abstract
Age-related changes in gastrointestinal symptoms need to be considered in peritoneal dialysis (PD) patients. A diminishing appetite is associated with aging and may be exacerbated by renal failure and PD treatment, meaning that attention to dietary adequacy is important in the older patient. Constipation and its treatment may increase the risk of peritonitis, but is important for comfort as well as trouble-free dialysis. Diverticulosis increases with age, and whilst there may be ethnic differences in the patterns of this condition, there is conflicting evidence regarding the risks of peritonitis associated with asymptomatic disease. Hernias, urinary incontinence, and prolapse are also common and made worse by PD, so it is important to know about these issues prior to starting. Whilst data around these topics are scant and some studies conflicting, further understanding these issues and considering mitigation strategies may improve technique survival and quality of life.
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Affiliation(s)
| | - Stephen G Holt
- Royal Melbourne Hospital, Melbourne, Australia The University of Melbourne, Melbourne, Australia
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Amro A, Waldum B, von der Lippe N, Brekke FB, Dammen T, Miaskowski C, Os I. Symptom clusters predict mortality among dialysis patients in Norway: a prospective observational cohort study. J Pain Symptom Manage 2015; 49:27-35. [PMID: 24858738 DOI: 10.1016/j.jpainsymman.2014.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with end-stage renal disease on dialysis have reduced survival rates compared with the general population. Symptoms are frequent in dialysis patients, and a symptom cluster is defined as two or more related co-occurring symptoms. OBJECTIVES The aim of this study was to explore the associations between symptom clusters and mortality in dialysis patients. METHODS In a prospective observational cohort study of dialysis patients (n = 301), Kidney Disease and Quality of Life Short Form and Beck Depression Inventory questionnaires were administered. To generate symptom clusters, principal component analysis with varimax rotation was used on 11 kidney-specific self-reported physical symptoms. A Beck Depression Inventory score of 16 or greater was defined as clinically significant depressive symptoms. Physical and mental component summary scores were generated from Short Form-36. Multivariate Cox regression analysis was used for the survival analysis, Kaplan-Meier curves and log-rank statistics were applied to compare survival rates between the groups. RESULTS Three different symptom clusters were identified; one included loading of several uremic symptoms. In multivariate analyses and after adjustment for health-related quality of life and depressive symptoms, the worst perceived quartile of the "uremic" symptom cluster independently predicted all-cause mortality (hazard ratio 2.47, 95% CI 1.44-4.22, P = 0.001) compared with the other quartiles during a follow-up period that ranged from four to 52 months. The two other symptom clusters ("neuromuscular" and "skin") or the individual symptoms did not predict mortality. CONCLUSION Clustering of uremic symptoms predicted mortality. Assessing co-occurring symptoms rather than single symptoms may help to identify dialysis patients at high risk for mortality.
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Affiliation(s)
- Amin Amro
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Bård Waldum
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nanna von der Lippe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fredrik Barth Brekke
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Ingrid Os
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway
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