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Wong TS, Chen Q, Liu T, Yu J, Gao Y, He Y, Zhong Q, Tan Z, Liu T, Lu J, Huang J, Zhang CJP, Yin L, Hu B, Ming WK. Patients, healthcare providers, and general population preferences for hemodialysis vascular access: a discrete choice experiment. Front Public Health 2024; 12:1047769. [PMID: 38784588 PMCID: PMC11112084 DOI: 10.3389/fpubh.2024.1047769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Background A patient-centered dialysis treatment option requires an understanding of patient preferences for alternative vascular accesses and nephrologists often face difficulties when recommending vascular access to end-stage kidney disease (ESKD) patients. We aimed to quantify the relative importance of various vascular access characteristics to patients, healthcare providers and general population, and how they affect acceptability for patients and healthcare providers. Methods In a discrete choice experiment, patients with maintenance hemodialysis (MHD), healthcare providers, and individuals from the general population were invited to respond to a series of hypothetical vascular access scenarios that differed in five attributes: cumulative patency, infection rate, thrombosis rate, cost, and time to maturation. We estimated the respondents' preference heterogeneity and relative importance of the attributes with a mixed logit model (MXL) and predicted the willingness to pay (WTP) of respondents via a multinomial logit model (MNL). Results Healthcare providers (n = 316) and the general population (n = 268) exhibited a favorable inclination toward longer cumulative patency, lower access infection rate and lower access thrombosis rate. In contrast, the patients (n = 253) showed a preference for a 3-year cumulative patency, 8% access infection rate, 35% access thrombosis rate and 1.5 access maturity time, with only the 3-year cumulative patency reaching statistical significance. Among the three respondent groups, the general population found cumulative patency less important than healthcare providers and patients did. Patients demonstrated the highest WTP for cumulative patency, indicating a willingness to pay an extra RMB$24,720(US$3,708) for each additional year of patency time. Conclusion Patients and healthcare providers had a strong preference for vascular access with superior patency. While the general population preferred vascular access with lower thrombosis rates. These results indicate that most patients prefer autogenous arteriovenous fistula (AVF) as an appropriate choice for vascular access due to its superior patency and lower complications than other vascular access types.
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Affiliation(s)
- Tak-Sui Wong
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Qian Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Jing Yu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yangyang Gao
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yan He
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Qiongqiong Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Tinlun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- International School, Jinan University, Guangzhou, China
| | - Jian Lu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, United Kingdom
| | - Casper J. P. Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lianghong Yin
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Bo Hu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Jeon J, Kim GO, Kim BY, Son EJ, Do JY, Lee JE, Kang SH. Effects of Kt/ Vurea on outcomes according to age in patients on maintenance hemodialysis. Clin Kidney J 2024; 17:sfae116. [PMID: 38766271 PMCID: PMC11099659 DOI: 10.1093/ckj/sfae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Indexed: 05/22/2024] Open
Abstract
Background The guidelines recommended target and minimum single-pool Kt/Vurea are 1.4 and 1.2, respectively, in hemodialysis patients. However, the optimal hemodialysis dose remains controversial. We investigated the effects of Kt/Vurea on patient outcomes according to age, with a focus on older patients. Methods This study used the hemodialysis quality assessment program and claims datasets. Patients were divided into four subgroups according to age (<65, 65-74, 75-84, and ≥85 years). Each group was divided into three subgroups according to Kt/Vurea : reference (ref) (1.2 ≤ Kt/Vurea ≤ 1.4), low (< 1.2), and high (> 1.4). Results The low, ref, and high Kt/Vurea groups included 1668, 8156, and 16 546 (< 65 years); 474, 3058, and 7646 (65-74 years); 225, 1362, and 4194 (75-84 years); and 14, 126, and 455 (≥85 years) patients, respectively. The low Kt/Vurea group had higher mortality rates than the ref Kt/Vurea group irrespective of age [adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.23, 1.11-1.36; 1.14, 1.00-1.30; 1.28, 1.09-1.52; and 2.10, 1.16-3.98, in patients aged <65, 65-74, 75-84, and ≥85 years, respectively]. The high Kt/Vurea group had lower mortality rates than the ref Kt/Vurea group in patients aged <65 and 65-74 years (aHR, 95% Cl: 0.87, 0.82-0.92 and 0.93, 0.87-0.99 in patients aged <65 and 65-74 years, respectively). Conclusions These results support the current recommendations of a minimum Kt/Vurea of 1.2 even in patients age ≥85 years. In young patients, Kt/Vurea above the recommended threshold can be beneficial for survival.
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Affiliation(s)
- Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gui Ok Kim
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Bo Yeon Kim
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Eun Jung Son
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Flythe JE, Forfang D, Gedney N, White DM, Wilkie C, Cavanaugh KL, Harris RC, Unruh M, Squillaci G, West M, Mansfield C, Soloe CS, Treiman K, Wood D, Hurst FP, Neuland CY, Saha A, Sheldon M, Tarver ME. Development of a Patient Preference Survey for Wearable Kidney Replacement Therapy Devices. KIDNEY360 2022; 3:1197-1209. [PMID: 35919522 PMCID: PMC9337889 DOI: 10.34067/kid.0001862022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 01/11/2023]
Abstract
Background Recent innovations have the potential to disrupt the current paradigm for kidney failure treatment. The US Food and Drug Administration is committed to incorporating valid scientific evidence about how patients weigh the benefits and risks of new devices into their decision making, but to date, premarket submission of patient preference information (PPI) has been limited for kidney devices. With input from stakeholders, we developed a survey intended to yield valid PPI, capturing how patients trade off the potential benefits and risks of wearable dialysis devices and in-center hemodialysis. Methods We conducted concept elicitation interviews with individuals receiving dialysis to inform instrument content. After instrument drafting, we conducted two rounds of pretest interviews to evaluate survey face validity, comprehensibility, and perceived relevance. We pilot tested the survey with in-center hemodialysis patients to assess comprehensibility and usability further. Throughout, we used participant input to guide survey refinements. Results Thirty-six individuals receiving in-center or home dialysis participated in concept elicitation (N=20) and pretest (N=16) interviews. Participants identified reduced fatigue, lower treatment burden, and enhanced freedom as important benefits of a wearable device, and many expressed concerns about risks related to device disconnection-specifically bleeding and infection. We drafted a survey that included descriptions of the risks of serious bleeding and serious infection and an assessment of respondent willingness to wait for a safer device. Input from pretest interviewees led to various instrument modifications, including treatment descriptions, item wording, and risk-level explanations. Pilot testing of the updated survey among 24 in-center hemodialysis patients demonstrated acceptable survey comprehensibility and usability, although 50% of patients required some assistance. Conclusions The final survey is a 54-item web-based instrument that will yield estimates of the maximal acceptable risk for the described wearable device and willingness to wait for wearable devices with lower risk.
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Affiliation(s)
- Jennifer E. Flythe
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, 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
| | | | - David M. White
- Kidney Health Initiative Patient and Family Partnership Council, Hillcrest Heights, Maryland
| | - Caroline Wilkie
- Kidney Health Initiative Patient and Family Partnership Council, Punta Gorda, Florida
| | - Kerri L. Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee,Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raymond C. Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Unruh
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Grace Squillaci
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Melissa West
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Carol Mansfield
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Cindy S. Soloe
- RTI Health Solutions, Research Triangle Park, North Carolina
| | | | - Dallas Wood
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Frank P. Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Carolyn Y. Neuland
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Anindita Saha
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Murray Sheldon
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E. Tarver
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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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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Goldman S, Chan CT. Dialysis Modality Decisions: Choosing Wisely! AMERICAN JOURNAL OF KIDNEY DISEASES 2022; 79:778-779. [DOI: 10.1053/j.ajkd.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
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