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Flythe JE, Forfang D, Harris RC, Wood D, Hurst FP, Tarver ME. Risk Tolerance in the Setting of Wearable Dialysis Devices: A Patient Preference Study Using the Threshold Technique. J Am Soc Nephrol 2023; 34:951-954. [PMID: 36918382 PMCID: PMC10278820 DOI: 10.1681/asn.0000000000000120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Jennifer E. Flythe
- Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, University of North Carolina (UNC) Kidney Center, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, North Carolina
| | - Derek Forfang
- Kidney Health Initiative Patient and Family Partnership Council, San Pablo, California
| | - Raymond C. Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dallas Wood
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Frank P. Hurst
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E. Tarver
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
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2
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Loor JM, Judd NS, Rice CM, Perea DD, Croswell E, Singh PP, Unruh M, Zhu Y, Sehgal AR, Goff SL, Bryce CL, Myaskovsky L. Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations. Contemp Clin Trials Commun 2022; 30:101015. [PMID: 36246997 PMCID: PMC9562954 DOI: 10.1016/j.conctc.2022.101015] [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: 05/23/2022] [Revised: 09/02/2022] [Accepted: 10/01/2022] [Indexed: 11/01/2022] Open
Abstract
Background Kidney transplant (KT) is the optimal treatment for kidney failure (KF), and although completion of KT evaluation is an essential step in gaining access to transplantation, the process is lengthy, time consuming, and burdensome. Furthermore, despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo KT. Methods The Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to facilitate KT evaluation: kidney transplant fast track (KTFT), a streamlined KT evaluation process; and peer navigators (PN), a peer-assisted evaluation program that incorporates motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether KTFT or PN can help patients overcome barriers to transplant listing. We will randomly assign patients to the two conditions. We will track participants' medical records and conduct surveys prior to their initial evaluation clinic visit and again after they complete or discontinue evaluation. Conclusion Our aims are to (1) compare KTFT and PN to assess improvements in kidney transplant (KT) related outcomes and cost effectiveness; (2) examine how each approach effects changes in cultural/contextual factors, KT concerns, KT knowledge, and KT ambivalence; and (3) develop a framework for widespread implementation of either approach. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in KT.
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Affiliation(s)
- Jamie M. Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Nila S. Judd
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Claudia M. Rice
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Diana D. Perea
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, United States
| | - Pooja P. Singh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Ashwini R. Sehgal
- Department of Medicine, Case Western Reserve University, United States
| | - Sarah L. Goff
- Department of Health Policy and Management, University of Massachusetts, Amherst, United States
| | - Cindy L. Bryce
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, United States
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States,Department of Internal Medicine, University of New Mexico, School of Medicine, United States,Corresponding author. Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States.
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3
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Richardson MM, Grandinetti A, Hilliard-Boone TS, Wilund KR, Wingard R, St. Peter WL, Logan D, Tentori F, Keller S, West M, Lacson E. Conceptual Framework for Patient-Reported Outcome Measures in Clinical Trials of Skeletal Muscle Cramping Experienced in Dialysis: A Kidney Health Initiative Workgroup Report. Clin J Am Soc Nephrol 2022; 17:1563-1574. [PMID: 35292531 PMCID: PMC9528264 DOI: 10.2215/cjn.11980921] [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: 01/28/2023]
Abstract
Skeletal muscle cramping is a common and bothersome symptom for patients on maintenance dialysis therapy, regardless of modality, and it has not been prioritized for innovative assessments or treatments. Research to prevent or treat skeletal muscle cramping in patients receiving dialysis is hindered by poorly understood pathophysiology, lack of an accepted definition, and the absence of a standardized measurement method. The Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and US Food and Drug Administration, convened a multidisciplinary workgroup to define a set of patient-reported outcome measures for use in clinical trials to test the effect of new dialysis devices, new KRTs, lifestyle/behavioral modifications, and medications on skeletal muscle cramping. Upon determining that foundational work was necessary, the workgroup undertook a multistep process to elicit concepts central to developing the basis for demonstrating content validity of candidate patient-reported outcome measures for skeletal muscle cramping in patients on dialysis. The workgroup sought to (1) create an accepted, patient-endorsed definition for skeletal muscle cramping that applies to all dialysis modalities, (2) construct a conceptual model for developing and evaluating a skeletal muscle cramping-specific patient-reported outcome measure, and (3) identify potential questions from existing patient-reported outcome measures that could be modified or adapted and subsequently tested in the dialysis population. We report the results of the workgroup's efforts, provide our recommendations, and issue a call to action to address the gaps in knowledge and research needs we identified. These action steps are urgently needed to quantify skeletal muscle cramping burden, assess the effect, and measure meaningful changes of new interventions to improve the experience of patients receiving dialysis and suffering from skeletal muscle cramping.
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Affiliation(s)
- Michelle M. Richardson
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
- Dialysis Clinic, Inc., Nashville, Tennessee
| | - Amanda Grandinetti
- Kidney Health Initiative Patient and Family Partnership Council, Kidney Health Initiative, Washington, DC
| | | | - Kenneth R. Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Champaign, Illinois
| | - Rebecca Wingard
- Fresenius Medical Care North America Clinical Services, Waltham, Massachusetts
| | | | - Dilani Logan
- American Institutes for Research, Health, Oakland, California
| | | | - San Keller
- American Institutes for Research, Health, Chapel Hill, North Carolina
| | | | - Eduardo Lacson
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
- Dialysis Clinic, Inc., Nashville, Tennessee
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4
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Agarwal R, Burton J, Gallieni M, Kalantar-Zadeh K, Mayer G, Pollock C, Szepietowski JC. Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus. Clin Kidney J 2022; 16:30-40. [PMID: 36726430 PMCID: PMC9871858 DOI: 10.1093/ckj/sfac187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Since the breakthrough of kidney replacement therapy, increases in life expectancy for patients with end-stage kidney disease have been limited. However, patients have become increasingly vocal that, although mortality and life expectancy matter to them, the quality of their life, and particularly the relief of symptoms associated with their treatment, are in many cases more important. The majority of dialysis-associated symptoms and adverse effects do not currently have any approved treatments in this patient population, with the few treatments that are available used off-label, frequently without proven efficacy, yet still potentially adding further adverse effects to patients' current symptom burden. This article will illustrate how understanding the pathophysiology of a single, particularly burdensome symptom of dialysis (chronic kidney disease-associated pruritus) resulted in the design, development and regulatory approval of a treatment for that symptom. The pathway described here can be applied to other symptoms associated with dialysis, meaning that if we cannot add years to patients' lives, we can at least add life to their remaining years.
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Affiliation(s)
| | - James Burton
- Department of Cardiovascular Sciences, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università Di Milano, Milano, Italy
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, CA, USA
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Carol Pollock
- Renal Research Laboratory, Kolling Institute, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
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5
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Tong A, Scholes-Robertson N, Hawley C, Viecelli AK, Carter SA, Levin A, Hemmelgarn BR, Harris T, Craig JC. Patient-centred clinical trial design. Nat Rev Nephrol 2022; 18:514-523. [PMID: 35668231 DOI: 10.1038/s41581-022-00585-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/09/2022]
Abstract
Patient involvement in clinical trial design can facilitate the recruitment and retention of participants as well as potentially increase the uptake of the tested intervention and the impact of the findings on patient outcomes. Despite these benefits, patients still have very limited involvement in designing and conducting trials in nephrology. Many trials do not address research questions and outcomes that are important to patients, including patient-reported outcomes that reflect how patients feel and function. This limitation can undermine the relevance, reliability and value of trial-based evidence for decision-making in clinical practice and health policy. However, efforts to involve patients with kidney disease are increasing across all stages of the trial process from priority setting, to study design (including selection of outcomes and approaches to improve participant recruitment and retention) and dissemination and implementation of the findings. Harnessing the patient voice in designing trials can ensure that efforts and resources are directed towards patient-centred trials that address the needs, concerns and priorities of patients living with kidney disease with the aim of achieving transformative improvements in care and outcomes.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Simon A Carter
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Brenda R Hemmelgarn
- Faculty of Medicine and Dentistry at University of Alberta, Edmonton, AB, Canada
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Pérez-Morales R, Buades-Fuster JM, Esteve-Simó V, Macía-Heras M, Mora-Fernández C, Navarro-González JF. Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis. J Clin Med 2022; 11:jcm11030861. [PMID: 35160312 PMCID: PMC8836773 DOI: 10.3390/jcm11030861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
The success of hemodialysis (HD) treatments has been evaluated using objective measures of analytical parameters, or machine-measured parameters, despite having available validated instruments that assess patient perspective. There is an emerging interest regarding the use and relevance of patient-related outcomes (PROs). Electronic PROs (ePROs) involve the use of electronic technology, provide rapid access to this information, and are becoming more widely used in clinical trials and studies to evaluate efficacy and safety. Despite the scarce literature, this review suggests that ePROs are useful in providing a more customized and multidimensional approach to patient management and in making better clinical decisions in relevant aspects such as vascular access, duration and frequency of dialysis sessions, treatment of anemia, mental health, fatigue, and quality of life. The purpose of this review is to raise interest in the systematic use of ePROs in HD and to promote the development of studies in this field, which can respond to the gaps in knowledge and contribute to the implementation of the use of ePROs through new technologies, helping to improve the quality of health care.
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Affiliation(s)
- Rosa Pérez-Morales
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
- Correspondence:
| | - Juan Manuel Buades-Fuster
- Nephrology Service, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07148 Palma, Spain;
- Fundació Institut d’Investigació Sanitària Illes Balears, Carretera de Valldemossa, 79, Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain
| | - Vicent Esteve-Simó
- Nephrology Service, Consorci Sanitari de Terrassa, Carretera Torrebonica, s/n, 08227 Terrassa, Spain;
| | - Manuel Macía-Heras
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
| | - Carmen Mora-Fernández
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan F. Navarro-González
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Tecnologías Biomédicas, Facultad de Ciencias de la Salud, Sección de Medicina, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
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7
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Rice CM, Singh PP, Judd NS, Jimenez EY, Blair CK, Washburn A, Calvin C, Steiber A, Zhu Y, Argyropoulos C, Unruh M, Dew MA, Myaskovsky L. Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology. J Ren Nutr 2022; 32:e1-e12. [PMID: 35227873 PMCID: PMC9058226 DOI: 10.1053/j.jrn.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/11/2022] Open
Abstract
Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes.
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Taylor K, Chu NM, Chen X, Shi Z, Rosello E, Kunwar S, Butz P, Norman SP, Crews DC, Greenberg KI, Mathur A, Segev DL, Shafi T, McAdams-DeMarco MA. Kidney Disease Symptoms before and after Kidney Transplantation. Clin J Am Soc Nephrol 2021; 16:1083-1093. [PMID: 34597266 PMCID: PMC8425607 DOI: 10.2215/cjn.19031220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n=190), and post-transplantation symptom score trajectories (mixed effects models). RESULTS At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (-0.06 points per month; 95% confidence interval, -0.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. CONCLUSIONS Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
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Affiliation(s)
- Kathryn Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhan Shi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen Rosello
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sneha Kunwar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Butz
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silas P. Norman
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Deidra C. Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Keiko I. Greenberg
- Department of Medicine, Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tariq Shafi
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Correspondence: Dr. Mara A. McAdams-DeMarco, Departments of Surgery and Epidemiology, Johns Hopkins, 615 North Wolfe Street, W6033, Baltimore, MD 21205.
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