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Alghamdi LS, Alonazi W. The utilization of renal dialysis: a comprehensive study in Saudi Arabia. BMC Public Health 2024; 24:1914. [PMID: 39014360 PMCID: PMC11253410 DOI: 10.1186/s12889-024-19450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Understanding the trend of utilization of renal dialysis in Saudi Arabia (SA) is fundamental as it provides a general overview of renal care. The practice of renal dialysis assists in identifying challenges, opportunities, and potential areas for improvement in the provision of the services. OBJECTIVES This research investigated the utilization of renal dialysis services in SA by exploring the number of renal dialysis centers, hemodialysis machines (HD), and peritoneodialysis patients. METHODS The dataset for this study was derived from a collaboration between the General Authority of Statistics (GaStat) and the Ministry of Health (MoH), focusing on indicators for renal dialysis centers and patients across health sectors in 2021. Analysis was conducted using MS Excel 365 and IBM SPSS Version 29, incorporating multiple regression techniques. The health sector was treated as the dependent variable. At the same time, the number of hemodialysis (HD) machines and the counts of HD and peritoneal dialysis patients were considered independent variables. RESULTS Around 275 renal dialysis centers, over 8000 HD machines, 20,440 HD patients, and 1,861 peritoneal patients were tallied from two resources. The findings revealed a negative relationship between the health sector and several renal dialysis centers and peritoneodialysis patients, as demonstrated by p < 0.05 in multiple regression analysis. CONCLUSION The number of renal dialysis centers influences the availability of HD machines, affecting the number of HD and peritoneodialysis patients. Most national patients preferred MoH over other semi-governmental and private sectors, and vice versa for non-Saudis.
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Affiliation(s)
- Loujain S Alghamdi
- Health Administration Department, College of Business Administration, King Saud University, Riyadh, Riyadh, 13242-8424, Saudi Arabia
| | - Wadi Alonazi
- Health Administration Department, College of Business Administration, King Saud University, Riyadh, Riyadh, 13242-8424, Saudi Arabia.
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2
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McIsaac M, Chan CT, Auguste BL. The need for individualizing teaching and assurance of knowledge transmission to patients training for home dialysis. Nephrology (Carlton) 2022; 27:733-738. [PMID: 35315965 DOI: 10.1111/nep.14040] [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: 12/19/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
Patients have varied learning styles and this has implications for home haemodialysis (HHD). Assessment tools directed toward understanding these styles remains understudied. As a consequence, this may lead to substandard retention rates or adverse events in HHD programs. As part of a continuous quality improvement initiative we have aimed to improve our understanding of patient learning styles and consequently tailor home dialysis training to individuals. To objectively determine knowledge translation and comprehension, irrespective of learning styles, we have introduced an objective structured clinical examination (OSCE). This assessment tool allows for further refinement of educational priorities by highlighting both deficiencies and strengths. Thereafter, an exit OSCE ensures patients attain an acceptable standard to complete home haemodialysis independently. We hope this tool will help shape future training criteria for HHD programs and consequently reduce adverse event rates.
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Affiliation(s)
- Mark McIsaac
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Bourne L Auguste
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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3
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Weinhandl ED. The coronavirus disease 2019 pandemic: the disruptor that maintenance dialysis never anticipated. Curr Opin Nephrol Hypertens 2022; 31:185-190. [PMID: 35086986 DOI: 10.1097/mnh.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The novel coronavirus 2019 (COVID-19) pandemic has upended maintenance dialysis in the United States. I review changes in prevalence, incidence, mortality, and other clinical outcomes among patients undergoing dialysis since March 2020, highlighting vulnerabilities in the current system and opportunities for improved care in the future. RECENT FINDINGS The number of dialysis patients in the United States declined between March 2020 and March 2021, an unprecedented year-over-year drop in the census. Some of the decline can be attributed to an early drop in patients initiating dialysis but most of the decline can be attributed to excess mortality. Kidney transplants also declined during the early part of the pandemic. Home dialysis utilization increased during 2020 but that increase was largely in line with secular trends. The rate of hospitalization for causes other than COVID-19 fell significantly during 2020. SUMMARY The epidemiology of dialysis in the United States is clearly modifiable, as it reflects decisions to initiate treatment, prescribe home therapies, and hospitalize patients with acute medical needs. On the other hand, some outcomes are powerfully guided by health outcomes in the general population, thus limiting the ability of dialysis providers and nephrologists to influence outcomes.
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Affiliation(s)
- Eric D Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
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de Jong RW, Jager KJ, Vanholder RC, Couchoud C, Murphy M, Rahmel A, Massy ZA, Stel VS. Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease. Nephrol Dial Transplant 2021; 37:126-138. [PMID: 33486525 PMCID: PMC8719583 DOI: 10.1093/ndt/gfaa342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Access to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD. METHODS We surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low-, middle- and high-gross domestic product purchasing power parity (GDP PPP). RESULTS In total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P < 0.05). Professionals' attitudes towards several treatments became more positive with increasing GDP (P < 0.05). Uptake of in-centre haemodialysis was sufficient to 73% of respondents, but many wanted increased uptake of home dialysis, Tx and CCM. Respondents experienced different barriers according to availability of specific treatments in their centre. The occurrence of barriers (financial, staff shortage, lack of space/supplies and patient related) decreased with increasing GDP (P < 0.05). CONCLUSIONS Differences in factors influencing modality choice when providing RRT or CCM to adults with ESKD were found among low-, middle- and high-GDP countries in Europe. Therefore a unique pan-European policy to improve access to treatments may be inefficient. Different policies for clusters of countries could be more useful.
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Affiliation(s)
- Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Raymond C Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent
University Hospital, Ghent, Belgium
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis La
Plaine, France
| | - Mark Murphy
- The Irish Kidney Association CLG, Dublin, Ireland
| | - Axel Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main,
Germany
| | - Ziad A Massy
- INSERM U1018, Équipe 5, Centre de Recherche en Epidémiologie et Santé des
Populations (CESP), Université Paris Saclay et Université Versailles Saint Quentin en
Yvelines (UVSQ), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris
(APHP), Hôpital Universitaire Ambroise Paré, Boulogne-Billancourt,
France
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
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Khan I, Pintelon L, Martin H, Khan RA. Exploring stakeholders and their requirements in the process of home hemodialysis: A literature review. Semin Dial 2021; 35:15-24. [PMID: 34505311 DOI: 10.1111/sdi.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
Providing home hemodialysis (HHD) therapy is a complex process that not only requires the use of a complex technology but also involves a diverse group of stakeholders, and each stakeholder has their requirements and may not share a common interest. Bringing them together will require the alignment of their interests. A process management perspective can help to accomplish the alignment of their interests. To align their interests, it is crucial to identify interest groups and understand their interests. The main objective of this paper is to identify the stakeholders and represents their interests as a list of requirements in the HHD process. An extensive literature review has been carried out and PubMed was used for literature extraction. In total, 1848 articles were retrieved of which 80 have fulfilled the inclusion criteria. A large array of actors is identified and their interests/requirements at different stages of the HHD process are represented in the form of a list. They have both common and conflicting requirements in the HHD process. If these requirements are aligned and balanced, a stakeholder's driven treatment process will be developed and a real improvement will be achieved in the treatment process.
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Affiliation(s)
- Ilyas Khan
- Center for Industrial Management, KU Leuven, Leuven, Belgium
| | | | - Harry Martin
- Faculty of Management, Sciences & Technology, Dutch Open University, Heerlen, The Netherlands
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Poinen K, Van Der Hoek M, Copland MA, Tennankore K, Canney M. Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies. KIDNEY360 2021; 2:1592-1599. [PMID: 35372972 PMCID: PMC8785775 DOI: 10.34067/kid.0006222020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with ESKD are encouraged to pursue home dialysis therapy with the aims of improving quality of life, increasing patient autonomy, and reducing cost to health care systems. In a multidisciplinary team setting, patients interact with nephrologists, nurses, and allied health staff, all of whom may influence a patient's modality choice. Our objective was to evaluate the perceptions of all renal team members toward home dialysis therapies. Methods We performed a cross-sectional survey of multidisciplinary renal team members across five renal programs in British Columbia, Canada. The survey contained questions regarding primary work area, modality preference, patient and system factors that may influence modality candidacy, perceived knowledge of home therapies, and need for further education. Results A total of 334 respondents (22 nephrologists, 172 hemodialysis nurses, 49 home nurses, 20 predialysis nurses, and 71 allied health staff) were included (48% response rate). All respondents felt that home dialysis was beneficial for patients who work or study, improved patients' quality of life, and provided cost savings to the system. Compared with in-center hemodialysis nurses, home therapies nurses were between five and nine times more likely to favor a home therapy for patients of older age, lower socioeconomic status, lower educational level, higher burden of comorbidities, and those lacking social supports. Nephrologists and patients were felt to have the most influence on modality choice, whereas dialysis nurses were seen as having the least effect on modality choice. Most respondents felt the need for further education in home therapies. Conclusions The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies among team members regarding patient-/system-level factors that may affect the candidacy of home therapies. Structured, focused, and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.
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Affiliation(s)
- Krishna Poinen
- University of British Columbia, Vancouver, British Columbia, Canada,BC Renal, Vancouver, British Columbia, Canada
| | | | - Michael A. Copland
- University of British Columbia, Vancouver, British Columbia, Canada,BC Renal, Vancouver, British Columbia, Canada
| | - Karthik Tennankore
- Division of Nephrology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Mark Canney
- BC Renal, Vancouver, British Columbia, Canada,Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Zhang R, Pu C, Cui X, Zhang N, Li X, Zheng F. Burden in primary family caregivers caring for uremic patients on maintenance peritoneal dialysis. Perit Dial Int 2020; 40:556-562. [PMID: 32735160 DOI: 10.1177/0896860820942628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Managing the burden of care for patients with chronic debilitating diseases is an important issue. Herein, we assessed the burden in primary family members caring for uremic patients on maintenance peritoneal dialysis. METHODS One hundred seventy caregivers and 170 patients were recruited. Self-perceived scoring along the Zarit Caregiver Burden Scale (ZCBS), World Health Organization Five-item Well-Being Index (WHO-5), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) were determined for caregivers. RESULTS There was an inverse relationship between ZCBS and WHO-5 or WEMWBS scores in caregivers, suggesting that the higher the burden, the lesser the self-perceived well-being. One hundred two of 170 caregivers (60%) reported mild to moderate burden, indicating a common presence of mild to moderate caring-related mental and physical stress. Moreover, 31 caregivers (18.2%) reported moderate to severe burden. Several patient disease factors, including diabetes and frailty, increased caregiver burden, while insurance coverage and out-of-pocket medical costs were also positively correlated. Caregivers who lived with patients and spent longer hours in caring-related activities had higher burden scores, while regular exercise seemed to partially alleviate the burden. CONCLUSION Our study clearly showed that caring for patients with maintenance peritoneal dialysis caused physical, mental, and social burden in family caregivers, with the extent of the stress being influenced by patients' disease severity and other demographic factors in both patients and caregivers.
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Affiliation(s)
- Rongzhi Zhang
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Congshan Pu
- Nursing Administrative Department, 540418The Second Hospital, Dalian Medical University, China
| | - Xiaohui Cui
- Advanced Institute for Medical Sciences, Dalian Medical University, China
| | - Ning Zhang
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Xue Li
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China
| | - Feng Zheng
- Department of Nephrology, Hemodialysis Center, Dalian Medical University, China.,Advanced Institute for Medical Sciences, Dalian Medical University, China
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Balzer MS, Clajus C, Eden G, Euteneuer F, Haller HG, Martin H, Patecki M, Schmitt R, Hiss M, Fuerholzer K. Patient Perspectives on Renal Replacement Therapy Modality Choice: A Multicenter Questionnaire Study on Bioethical Dimensions. Perit Dial Int 2019; 39:519-526. [PMID: 31337700 DOI: 10.3747/pdi.2018.00285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/01/2019] [Indexed: 11/15/2022] Open
Abstract
Background:Peritoneal dialysis (PD) incidence and prevalence in Germany are low compared with hemodialysis (HD), an underachievement with multifactorial causes. Patient perspectives on renal replacement therapy (RRT) choice play a growing role in research. To date, and to the best of our knowledge, the importance of bioethical dimensions in the context of RRT choice has not been analyzed. The aim of this multicenter questionnaire study was to delineate differences in patient perspectives of PD vs HD in terms of bioethical dimensions, thus helping nephrologists target potential PD candidates more efficiently.Methods:A total of 121 stable outpatients from 2 tertiary care hospitals and 4 dialysis clinics were surveyed for bioethical dimensions ("autonomy," "beneficence," "non-maleficence," "justice," and "trust") with ranking and Likert scale items. Inclusion criteria were RRT > 3 months, age ≥ 18 years, and sufficient cognitive and language skills.Results:A surprisingly high percentage of patients felt excluded from the RRT choice process. Peritoneal dialysis patients were more critical of RRT. They used more versatile information sources on RRT, whereas HD patients were mainly informed by their nephrologist. Peritoneal dialysis patients felt more often dissatisfied with RRT than HD patients and had less trust in their co-patients. However, PD patients felt less autonomy impairment regarding body integrity, fluid balance, and dialysis in general.Conclusions:Our study demonstrates that PD patients showed more scrutiny of their situation as patients, especially their co-patients. Their treatment empowered them toward feeling more autonomous than HD patients. These new insights into patient perspectives on RRT choice might facilitate modality choice for nephrologists.
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Affiliation(s)
- Michael S Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | - Gabriele Eden
- Department of Nephrology and Hypertension, Staedtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Frank Euteneuer
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Hermann G Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | - Margret Patecki
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Center for Renal, Hypertensive and Metabolic Disorders, Hannover, Germany
| | - Roland Schmitt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Kuratorium fuer Dialyse und Nierentransplantation e.V., Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Kuratorium fuer Dialyse und Nierentransplantation e.V., Hannover, Germany
| | - Katharina Fuerholzer
- Language and Ethics Task Force, German Academy for Ethics in Medicine, Goettingen, Germany
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Wilkie M. Starting Dialysis—Planning for the Unpredictable and the Search for Meaningful Process Measures. Perit Dial Int 2018; 38:317-318. [DOI: 10.3747/pdi.2018.00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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