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Hawkins J, Smeeton N, Busby A, Wellsted D, Rider B, Jones J, Steenkamp R, Stannard C, Gair R, van der Veer SN, Corps C, Farrington K. Contributions of treatment centre and patient characteristics to patient-reported experience of haemodialysis: a national cross-sectional study. BMJ Open 2021; 11:e044984. [PMID: 33853800 PMCID: PMC8054084 DOI: 10.1136/bmjopen-2020-044984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine the relative importance of patient and centre level factors in determining self-reported experience of care in patients with advanced kidney disease treated by maintenance haemodialysis (HD). DESIGN Analysis of data from a cross sectional national survey; the UK Renal Registry (UKRR) national Kidney patient-reported experience measure (PREM) survey (2018). Centre-level data were obtained from the UKRR report (2018). SETTING National survey of patients with advanced kidney disease receiving treatment with maintenance HD in UK renal centres in 2018. PARTICIPANTS The Kidney PREM was distributed to all UK renal centres by the UKRR in May 2018. Each centre invited patients receiving outpatient treatment for kidney disease to complete the PREM. These included patients with chronic kidney disease, those receiving dialysis-both HD and peritoneal dialysis, and those with a functioning kidney transplant. There were no formal inclusion/exclusion criteria. MAIN OUTCOME MEASURES The Kidney PREM has 38 questions in 13 subscales. Responses were captured using a 7-point Likert scale (never 1, always 7). The primary outcome of interest was the mean PREM score calculated across all questions. Multilevel modelling was used to determine the proportion of variation of the mean PREM score across centres due to patient-related and centre-related factors. RESULTS There were records for 8253 HD patients (61% men, 77% white) from 69 renal centres (9-710 patients per centre). There was significant variation in mean PREM score across centres (5.35-6.53). In the multivariable analysis there was some variation in relation to both patient- and centre-level factors but these contributed little to explaining the overall variation. However, multilevel modelling showed that the overwhelming proportion of the explained variance (45%) was explained by variation between centres (40%), only a small proportion of which is identified by measured factors. Only 5% of the variation was related to patient-level factors. CONCLUSIONS Centre rather than patient characteristics determine the experience of care of patients receiving HD. Further work is required to define the characteristics of the treating centre which determine patient experience.
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Affiliation(s)
- Janine Hawkins
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Nigel Smeeton
- Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Amanda Busby
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - David Wellsted
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Beth Rider
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Julia Jones
- Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | | | - Rachel Gair
- UK Renal Registry, Renal Association, Bristol, UK
| | | | - Claire Corps
- St James's University Teaching Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ken Farrington
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Renal Unit, Lister Hospital, Stevenage, UK
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Debnath S, Rueda R, Bansal S, Kasinath BS, Sharma K, Lorenzo C. Fatigue characteristics on dialysis and non-dialysis days in patients with chronic kidney failure on maintenance hemodialysis. BMC Nephrol 2021; 22:112. [PMID: 33773596 PMCID: PMC7999524 DOI: 10.1186/s12882-021-02314-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Fatigue is prevalent in hemodialysis patients who for survival follow a strict dialysis treatment regimen - dialysis and non-dialysis days. As a result, the daily activities, symptom burden, and clinical outcomes of hemodialysis patients vary significantly between dialysis and non-dialysis days. Fatigue is one of the most reported debilitating symptoms by hemodialysis patients with profound negative impact on their quality of life. Prior studies assessed fatigue during the preceding 7 or 30 days and did not discriminate fatigue characteristics between dialysis and non-dialysis days. We aimed to characterize and compare fatigue severity and fatigue interference with daily activities between dialysis and non-dialysis days. METHODS Hemodialysis patients self-reported fatigue on consecutive dialysis and non-dialysis days using the 9-item Brief Fatigue Inventory. The differences in fatigue characteristics between dialysis and non-dialysis days were analyzed using one-way ANCOVA. RESULTS Global fatigue burden was worse on a dialysis day compared to a non-dialysis day (P for all < 0.001). Age and education were associated with fatigue, but hemodialysis-related variables were not. A significant inverse association of physical activity with fatigue severity observed on non-dialysis day; there was also a negative association between the normalized protein catabolic rate and fatigue severity on both dialysis and non-dialysis days. The positive association of depression with fatigue severity and fatigue interference were consistent on both dialysis and non-dialysis days. None of these factors, however, explained differences in fatigue characteristics between dialysis and non-dialysis days. CONCLUSIONS Fatigue, measured in severity and interference, was more pronounced on a dialysis day relative to a non-dialysis day. These differences were not explained by age, sex, education, hemodialysis-related variables, habitual exercise, nutritional status, and or depression. The quantitative measures of fatigue characteristics may facilitate future interventional trials design and better fatigue management for hemodialysis patients.
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Affiliation(s)
- Subrata Debnath
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA.
| | - Rain Rueda
- University Health, 4502 Medical Dr, San Antonio, TX, USA
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA
| | - Balakuntalam S Kasinath
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA
| | - Kumar Sharma
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA
| | - Carlos Lorenzo
- Division of Clinical Immunology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA
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Song MK, Paul S, Plantinga L, Henry C, Turberville-Trujillo L. Social Networks of Self-care and Perceived Treatment Burden Among Patients on In-Center Hemodialysis. Kidney Med 2019; 1:97-103. [PMID: 32734190 PMCID: PMC7380407 DOI: 10.1016/j.xkme.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dialysis patients manage not only the demand of dialysis but also other complex chronic conditions. These individuals may draw upon personal and social resources to cope with the demands of self-management and care coordination. This study was designed to describe social networks for self-management and care coordination among hemodialysis patients and explore the association between network characteristics and perceived treatment burden. STUDY DESIGN A cross-sectional study using social network analysis. SETTING & PARTICIPANTS 20 patients from an outpatient dialysis center. FACTORS Social network characteristics (eg, size and connectivity) and perceived treatment burden. MEASUREMENTS/OUTCOMES Participants completed a battery of questionnaires, including the Patient Experience With Treatment and Self-management Questionnaire (measuring perceived treatment burden) and a social network survey asking the respondent to name up to 5 people to whom he or she turned for help with self-care and care coordination tasks and their characteristics and relationships. RESULTS Participants were aged 53.4 years on average, half were women, and 18 were African Americans. On average, network size was 3.1 members, most of whom were women and family members. 7 patient networks included at least 1 health care provider. The clustering coefficient (the overall connection between members) was 0.54, suggesting that not all members within the patient's network were connected with each other. Multimorbidity was not associated with treatment burden domain scores, but greater network connectivity was associated with lower treatment-related financial burden (r = -0.61). LIMITATIONS The small sample was racially homogeneous and precluded controlling for potential confounding factors. CONCLUSIONS Dialysis patients used networks of people to manage self-care and coordination tasks, but interconnectedness between members of individual patients' networks was limited, which might negatively affect their perceived treatment burden. The social context of dialysis patients could play an important role in their illness management and treatment burden and calls for future research.
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Affiliation(s)
- Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Laura Plantinga
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Carrie Henry
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Iwashita Y, Ohya M, Kunimoto S, Iwashita Y, Mima T, Negi S, Shigematsu T. A Survey of Drug Burden in Patients Undergoing Maintenance Hemodialysis in Japan. Intern Med 2018; 57:2937-2944. [PMID: 29780106 PMCID: PMC6232020 DOI: 10.2169/internalmedicine.0108-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/15/2017] [Indexed: 11/06/2022] Open
Abstract
Objective This report presents a part of a survey pertaining to drug burden in maintenance hemodialysis patients in Japan. Methods A patient-reported questionnaire-based survey was conducted from September to November 2016 in six regions in Japan. Patients A total of 700 patients (50-79 years old) on maintenance hemodialysis for >3 years and members of the Japan Association of Kidney Disease Patients (JAKDP) were provided with the questionnaire. They were randomly selected using stratified sampling according to patient distribution observed from the Japanese Society for Dialysis Therapy Renal Data Registry (JSDT JRDR). Results A total of 524 (74.9%) patient questionnaires were evaluated [mean (standard deviation; SD) age, 66.6 (7.2) years; males, 63.4%; dialysis vintage, 16.9 (9.1) years]. Patients' age, gender, and regional distribution were similar to the JSDT JRDR. They were taking an average (SD) of 16.4 (8.34) and 16.3 (8.55) oral medications/day on dialysis and nondialysis days, respectively. A majority of the patients were taking ≥10 oral medications/day on dialysis (75.1%) and nondialysis (74.4%) days, with phosphate binders being the most taken (7.0 tablets/day). A similar proportion (74.4%, 72.9%, respectively) was taking ≥6 different types of oral medications/day. Most patients were taking oral medications 3 (31%, 33%), 4 (24%, 22%), and ≥5 times (31%, 30%) a day, respectively. The drug burden was similar on dialysis and nondialysis days and did not vary with dialysis vintage. Conclusion The number, type, and frequency of oral medications in maintenance hemodialysis patients are high in Japan. The proportion of phosphate binders was highest among the prescription medications.
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Affiliation(s)
- Yuko Iwashita
- Department of Nephrology, Wakayama Medical University, Japan
| | - Masaki Ohya
- Department of Nephrology, Wakayama Medical University, Japan
| | - Satoko Kunimoto
- Department of Nephrology, Wakayama Medical University, Japan
| | - Yu Iwashita
- Department of Nephrology, Wakayama Medical University, Japan
| | - Toru Mima
- Department of Nephrology, Wakayama Medical University, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Japan
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Song MK, Paul S, Ward SE, Gilet CA, Hladik GA. One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis. Am J Kidney Dis 2018; 72:198-204. [PMID: 29395483 PMCID: PMC6057855 DOI: 10.1053/j.ajkd.2017.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis. STUDY DESIGN Longitudinal observational study. SETTING & PARTICIPANTS 227 patients recruited from 12 dialysis centers. FACTORS Sociodemographic and clinical characteristics. MEASUREMENTS/OUTCOMES Participants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient's Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time. RESULTS Although dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (all P<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (all P<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time. LIMITATIONS Study was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied. CONCLUSIONS Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.
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Affiliation(s)
- Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Sudeshna Paul
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sandra E Ward
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Constance A Gilet
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gerald A Hladik
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Henry SL, Jamner LD, Choi SE, Pahl MV. The effect of the interdialytic interval on cognitive function in patients on haemodialysis. J Ren Care 2017; 44:44-51. [PMID: 29271080 DOI: 10.1111/jorc.12231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction may shift over the course of the interdialytic interval. OBJECTIVES To use ecological momentary assessment (EMA) to examine the relationship between the length of the interdialytic interval and reports of cognitive dysfunction. DESIGN A quantitative study whereby each patient's cognitive functioning was measured during both short and long interdialytic intervals. PARTICIPANTS Adults maintained on HD (Female n = 15, Male n = 11; MAge = 42.7 ± 15.8 years) were drawn from a standalone HD unit within a large university medical centre. MEASUREMENTS Tests of baseline neurocognitive functioning were undertaken (Mini-Mental Status Examination, Digit Span, California Verbal Learning Test, Benton Visual Retention Test, Trail-Making Test) and smartphone-based electronic diary reports of cognitive impairment were made around six times each day for one week. RESULTS Cognitive function and aptitude in this sample, although low, did not reflect clinically-significant impairment, with a mean Mini-Mental Status Exam score of 25.7 ± 3.0. Diary reports of cognitive impairment were also minimal, with an overall mean rating of .22 out of 5. Contrary to expectations, cognitive impairment was significantly greater on the one-day interdialytic days than on Day 2 of the two-day interdialytic interval (β = .094, p = .017). CONCLUSIONS Although cognitive impairment appears to be mild in stable, young patients with end stage renal disease, volumetric disruptions caused by HD may exacerbate such dysfunction.
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Affiliation(s)
- Shayna L Henry
- Kaiser Permanente Southern California Department of Clinical Analysis, Pasadena, California, USA
| | - Larry D Jamner
- Department of Psychology & Social Behavior, University of California, Irvine, Irvine, California, USA
| | - Sarah E Choi
- School of Nursing, University of California, Los Angeles, California, USA
| | - Madeleine V Pahl
- Division of Nephrology and Hypertension, School of Medicine, University of California, Irvine, Orange, California, USA
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The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study. Int Urol Nephrol 2017; 50:143-154. [PMID: 29159509 DOI: 10.1007/s11255-017-1738-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to evaluate the prevalence of depression and anxiety in hemodialyzed patients in Greece and its association with socio-demographic factors. METHODS Four hundred and fourteen (414) patients on hemodialysis (262 males and 152 females) from 24 dialysis centers in Greece participated in this observational cross-sectional study. Mean age was 63.54 (54.06-72.41), and mean time of dialysis treatment was 36 (16-72) months. Depression and anxiety were assessed by the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels (HADS scale). Multiple linear regression was performed to estimate the factors being independently associated with BDI and STAI. RESULTS From a total of 414 participants, (29.4%, n = 122) had depression and 35.9% (n = 149) had anxiety. Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidities. CONCLUSION The overall study findings indicated a significant correlation between the levels of anxiety and depression in patients on hemodialysis. Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.
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Einollahi B, Motalebi M, Rostami Z, Nemati E, Salesi M. Sleep quality among Iranian hemodialysis patients: a multicenter study. Nephrourol Mon 2014; 7:e23849. [PMID: 25738125 PMCID: PMC4330687 DOI: 10.5812/numonthly.23849] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/12/2014] [Indexed: 12/20/2022] Open
Abstract
Background: Sleep disorders are prevalent complication in patients with end-stage renal disease undergoing hemodialysis (HD). The factors affecting sleep quality (SQ) of patients on HD have not been completely recognized yet. In addition, some studies have shown that poor SQ increases the risk of mortality in patients on HD. Objectives: This study aimed to identify the prevalence of poor SQ and its associated risk factors in Iranian patients on HD. Patients and Methods: This cross-sectional and multicenter study was conducted on 6878 patients on HD from 132 dialysis centers in Iran. Sleep domain of disease specific core of KDCS-SF questionnaire and generic core of this questionnaire (SF-36) were used to assess patients’ SQ and quality of life (QoL), respectively. A poor SQ was defined as a score of ≤ 61.2. Logistic and linear regression analyses were applied to assess predictors of SQ and their associations. Results: The mean age of patients was 54.4 ± 17.1 years and 39.7% of patients were > 60 years old. The majority of our patients had poor SQ (60.6%). Patients with diabetes mellitus were significantly more likely to have poor quality of sleep (63.4%). In logistic regression analysis, there were significant correlation between good SQ and younger age, shorter dialysis vintage, less muscle cramp, high QoL, high cognitive function score, and high sexual function. In addition, linear regression showed a significant association among SQ, QoL, and hospital stay as an outcome. Conclusions: With improving some factors and QoL of patients on HD, we can promote SQ in these patients that it might lead to reduction in length of hospital stay.
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Affiliation(s)
- Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Motalebi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Motalebi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181262073, Fax: +98-2181262073, E-mail:
| | - Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Salesi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Illness trajectories and their relevance to the care of adults with kidney disease. Curr Opin Nephrol Hypertens 2014; 22:316-24. [PMID: 23518464 DOI: 10.1097/mnh.0b013e32835ffaaf] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Existing practice guidelines for chronic kidney disease advocate a stage-based approach to management, in which treatment recommendations are based largely on the severity of kidney disease, and future risk for adverse health outcomes. However, the course of kidney disease can vary widely among patients with similar levels of kidney function, and each patient will experience their illness in unique ways. RECENT FINDINGS We summarize recent studies of patterns of kidney function over time among patients with chronic kidney disease, and discuss these findings in the context of relevant conceptual models of illness and communication. Although knowledge of disease severity can provide useful information on life expectancy and risk for future health events, an understanding of each patient's illness trajectory and their unique experience of illness is essential in supporting patient-centered care for patients with kidney disease. This information can be helpful in setting realistic expectations for the future, in communicating about prognosis and in aligning treatment decisions with each patient's goals and preferences. SUMMARY We here explain how an understanding of illness trajectories may be useful in predicting and guiding care and decision-making in patients with kidney disease. We highlight the importance of competing disease trajectories, the heterogeneity in renal function trajectories among patients with kidney disease, and the variability in these trajectories over time in individual patients. We discuss how individual disease trajectories can shape each patient's experience of illness. Finally, we explain how an understanding of an individual patient's illness trajectory and experience of illness may be useful in guiding discussions about prognosis and treatment decisions and in supporting a patient-centered approach to care.
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Song MK, Ward SE, Bair E, Weiner LJ, Bridgman JC, Hladik GA, Gilet CA. Patient-reported cognitive functioning and daily functioning in chronic dialysis patients. Hemodial Int 2014; 19:90-9. [PMID: 25110172 DOI: 10.1111/hdi.12202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Subjective cognitive impairment negatively affects daily functioning, health-related quality of life, and health care consumption, and is predictive of future cognitive decline in many patient populations. However, no subjective measures of multidimensional cognitive functioning have been evaluated for dialysis patients. Our purposes were to examine (1) the association between patient-reported (subjective) cognitive functioning and objective cognitive functioning and (2) the relationships between subjective and objective cognitive functioning and everyday functioning of dialysis patients. We used baseline data from an ongoing longitudinal observational study of trajectories in dialysis patients' multidimensional quality of life. One hundred thirty-five patients completed a telephone-based neuropsychological battery (Brief Test of Adult Cognition by Telephone, a measure of objective cognitive functioning), a measure of subjective cognitive functioning (Patient's Assessment of Own Functioning Inventory), and measures of everyday functioning (Activities of Daily Living [ADL] and Instrumental Activities of Daily Living [IADL] scales). After controlling for age and education, there was a modest correlation (r = 0.33, P > 0.001) between subjective and objective cognitive functioning. Multivariate logistic regression models showed subjective, but not objective, cognitive functioning was a significant predictor of both ADLs and IADLs. The findings suggest the potential clinical value of subjective measures of cognitive functioning, not to replace objective measures or diagnostic tests, but rather to optimize the meaningfulness of clinical assessment and management.
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Affiliation(s)
- Mi-Kyung Song
- Adult/Geriatric Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abdel-Kader K, Jhamb M, Mandich LA, Yabes J, Keene RM, Beach S, Buysse DJ, Unruh ML. Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD. BMC Nephrol 2014; 15:29. [PMID: 24502751 PMCID: PMC3927224 DOI: 10.1186/1471-2369-15-29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Many patients on maintenance dialysis experience significant sleepiness and fatigue. However, the influence of the hemodialysis (HD) day and circadian rhythms on patients’ symptoms have not been well characterized. We sought to use ecological momentary assessment to evaluate day-to-day and diurnal variability of fatigue, sleepiness, exhaustion and related symptoms in thrice-weekly maintenance HD patients. Methods Subjects used a modified cellular phone to access an interactive voice response system that administered the Daytime Insomnia Symptom Scale (DISS). The DISS assessed subjective vitality, mood, and alertness through 19 questions using 7- point Likert scales. Subjects completed the DISS 4 times daily for 7 consecutive days. Factor analysis was conducted and a mean composite score of fatigue-sleepiness-exhaustion was created. Linear mixed regression models (LMM) were used to examine the association of time of day, dialysis day and fatigue, sleepiness, and exhaustion composite scores. Results The 55 participants completed 1,252 of 1,540 (81%) possible assessments over the 7 day period. Multiple symptoms related to mood (e.g., feeling sad, feeling tense), cognition (e.g., difficulty concentrating), and fatigue (e.g., exhaustion, feeling sleepy) demonstrated significant daily and diurnal variation, with higher overall symptom scores noted on hemodialysis days and later in the day. In factor analysis, 4 factors explained the majority of the observed variance for DISS symptoms. Fatigue, sleepiness, and exhaustion loaded onto the same factor and were highly intercorrelated. In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 – 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 – 0.41]. Observed associations were minimally affected by adjustment for demographics and common confounders. Conclusions Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation. The variability in symptoms may contribute to poor symptom awareness by providers and greater misclassification bias of fatigue related symptoms in clinical studies.
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Affiliation(s)
- Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN S-3223, Nashville, TN 37232-2372, USA.
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Amro A, Waldum B, Dammen T, Miaskowski C, Os I. Symptom clusters in patients on dialysis and their association with quality-of-life outcomes. J Ren Care 2014; 40:23-33. [PMID: 24438743 DOI: 10.1111/jorc.12051] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients who are on dialysis report multiple symptoms. The aim of the study was to explore and identify symptom clusters (co-occurring symptoms) in patients on dialysis and their possible associations with depressive symptoms and health-related quality-of-life (HRQOL) outcomes. METHODS In a cross-sectional study of 301 prevalent patients on dialysis, physical symptoms, depressive symptoms and HRQOL were assessed using the Beck Depression Inventory (BDI) and the Kidney Disease and Quality-of-Life-Short Form version 1.3 (KDQOL-SF36) questionnaires. Symptom clusters were identified using principal component analysis with varimax rotation. Multivariate linear regression analyses were carried out to evaluate the relationships between symptom clusters and depressive symptoms and HRQOL outcomes. RESULTS The majority of patients (63.5%) rated their symptoms in the 'very much' to 'extremely bothersome' range, and 29.4% had significant depressive symptoms. Three symptom clusters were identified and were named uraemic (nausea, lack of appetite, dizziness/faintness, feeling squeezed out, shortness of breath, chest pain), neuromuscular (numbness in extremities, sore muscles, cramps) and skin (itching, dry skin) clusters. The three clusters were associated with BDI, physical component summary (PCS) and mental component summary (MCS) scores. After multiple adjustments, the uraemic and neuromuscular clusters remained independently associated with BDI and PCS scores and the uraemic and skin clusters with MCS scores. CONCLUSION The strong associations between symptom clusters and depressive symptoms and the physical and mental domains of HRQOL should lead to an increased focus on symptom-alleviating interventions. Additional research is warranted to determine whether treatment of symptom clusters rather than single symptoms will improve HRQOL.
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Affiliation(s)
- Amin Amro
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
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Mazzoni D, Cicognani E, Laghi M, Sgarlato V, Mosconi G. Patients' direction, empowerment and quality of life in haemodialysis. PSYCHOL HEALTH MED 2013; 19:552-8. [PMID: 24215533 DOI: 10.1080/13548506.2013.855316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The maintenance of an adequate of quality of life (QoL) represents a critical issue in the management of patients in haemodialysis and is also used to assess the effectiveness of health care programmes. The Consumer Direction Theory of Empowerment (CDTE) implies that greater patient direction in policy formulation and services delivery, together with an increased community integration, endorses a process which leads to a better QOL. The aim of the study was to test a contextualized version of CDTE in an ambulatory for patients in haemodialysis. Sixty-nine patients completed a questionnaire measuring the following variables: Patient direction, family integration, self-efficacy in managing the disease, mental and physical health. The results showed that patient direction and family integration have an indirect effect on QoL, through self-efficacy in managing the disease. The hypotheses were thus confirmed, providing support for the potential of CDTE in the context of health services for haemodialysis patients. Implications for the implementation of health programmes aimed at improving QoL of patients in haemodialysis are discussed, including interventions focused on psychological and contextual factors.
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Affiliation(s)
- Davide Mazzoni
- a Department of Psychology , University of Bologna , Bologna , Italy
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Wang MY, Chan SF, Chang LI, Chen TH, Tsai PS. Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: A cross-sectional observational study. Int J Nurs Stud 2013; 50:1468-73. [DOI: 10.1016/j.ijnurstu.2013.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 02/09/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
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Song MK, Lin FC, Gilet CA, Arnold RM, Bridgman JC, Ward SE. Patient perspectives on informed decision-making surrounding dialysis initiation. Nephrol Dial Transplant 2013; 28:2815-23. [PMID: 23901048 PMCID: PMC3811056 DOI: 10.1093/ndt/gft238] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Careful patient-clinician shared decision-making about dialysis initiation has been promoted, but few studies have addressed patient perspectives on the extent of information provided and how decisions to start dialysis are made. METHODS Ninety-nine maintenance dialysis patients recruited from 15 outpatient dialysis centers in North Carolina completed semistructured interviews on information provision and communication about the initiation of dialysis. These data were examined with content analysis. In addition, informed decision-making (IDM) scores were created by summing patient responses (yes/no) to 10 questions about the decision-making. RESULTS The mean IDM score was 4.4 (of 10; SD = 2.0); 67% scored 5 or lower. Age at the time of decision-making (r = -0.27, P = 0.006), years of education (r = 0.24, P = 0.02) and presence of a warning about progressing to end-stage kidney disease (t = 2.9, P = 0.005) were significantly associated with IDM scores. Nearly 70% said that the risks and burdens of dialysis were not mentioned at all, and only one patient recalled that the doctor offered the option of not starting dialysis. While a majority (67%) said that they felt they had no choice about starting dialysis (because the alternative would be death) or about dialysis modality, only 21.2% said that they had felt rushed to make a decision. About one-third of the patients perceived that the decision to start dialysis and modality was already made by the doctor. CONCLUSIONS A majority of patients felt unprepared and ill-informed about the initiation of dialysis. Improving the extent of IDM about dialysis may optimize patient preparation prior to starting treatment and their perceptions about the decision-making process.
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Affiliation(s)
- Mi-Kyung Song
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Constance A. Gilet
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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