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Weiner DE, Delgado C, Flythe JE, Forfang DL, Manley T, McGonigal LJ, McNamara E, Murphy H, Roach JL, Watnick SG, Weinhandl E, Willis K, Berns JS. Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:636-647. [PMID: 37972814 DOI: 10.1053/j.ajkd.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023]
Abstract
Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.
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Affiliation(s)
| | - Cynthia Delgado
- San Francisco Veterans Affairs Health Care System and the University of California, San Francisco, CA
| | | | | | | | | | | | | | | | - Suzanne G Watnick
- Northwest Kidney Centers, Seattle, WA; University of Washington, Seattle, WA; Puget Sound VA, Seattle, WA
| | - Eric Weinhandl
- University of Minnesota, Minneapolis, MN; Satellite Healthcare, San Jose, CA
| | | | - Jeffrey S Berns
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Pena Prado A, Caron A. [Implementing vascular access protection indicators (VAPI) in dialysis: an innovation in quality of care]. Rev Infirm 2024; 73:30-33. [PMID: 38643999 DOI: 10.1016/j.revinf.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Between 2013 and 2021, indicators of vascular access protection (IPAV) integrating a census of haematomas and multiple punctures were set up on the active file of chronic kidney failure patients with a vascular access dialyzed in Monaco's private haemodialysis center. They could help reduce the occurrence of complications and improve the quality of care offered to patients. This article reports on the results obtained before and after the introduction of this quality approach.
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Affiliation(s)
- Angeline Pena Prado
- Centre d'hémodialyse privé de Monaco, Elsan, 32-34 quai Jean-Charles-Rey, 98000 Monaco.
| | - Alexandre Caron
- Cemka, 43 boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
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Lazarus B, Polkinghorne KR, Gallagher M, Coggan S, Gray NA, Talaulikar G, Kotwal S. Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study. Am J Kidney Dis 2024; 83:445-455. [PMID: 38061534 DOI: 10.1053/j.ajkd.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 01/15/2024]
Abstract
RATIONALE & OBJECTIVE Hemodialysis catheter dysfunction is an important problem for patients with kidney failure. The optimal design of the tunneled catheter tip is unknown. This study evaluated the association of catheter tip design with the duration of catheter function. STUDY DESIGN Observational cohort study using data from the nationwide REDUCCTION trial. SETTING & PARTICIPANTS 4,722 adults who each received hemodialysis via 1 or more tunneled central venous catheters in 37 Australian nephrology services from December 2016 to March 2020. EXPOSURE Design of tunneled hemodialysis catheter tip, classified as symmetrical, step, or split. OUTCOME Time to catheter dysfunction requiring removal due to inadequate dialysis blood flow assessed by the treating clinician. ANALYTICAL APPROACH Mixed, 3-level accelerated failure time model, assuming a log-normal survival distribution. Secular trends, the intervention, and baseline differences in service, patient, and catheter factors were included in the adjusted model. In a sensitivity analysis, survival times and proportional hazards were compared among participants' first tunneled catheters. RESULTS Among the study group, 355 of 3,871 (9.2%), 262 of 1,888 (13.9%), and 38 of 455 (8.4%) tunneled catheters with symmetrical, step, and split tip designs, respectively, required removal due to dysfunction. Step tip catheters required removal for dysfunction at a rate 53% faster than symmetrical tip catheters (adjusted time ratio, 0.47 [95% CI, 0.33-0.67) and 76% faster than split tip catheters (adjusted time ratio, 0.24 [95% CI, 0.11-0.51) in the adjusted accelerated failure time models. Only symmetrical tip catheters had performance superior to step tip catheters in unadjusted and sensitivity analyses. Split tip catheters were infrequently used and had risks of dysfunction similar to symmetrical tip catheters. The cumulative incidence of other complications requiring catheter removal, routine removal, and death before removal were similar across the 3 tip designs. LIMITATIONS Tip design was not randomized. CONCLUSIONS Symmetrical and split tip catheters had a lower risk of catheter dysfunction requiring removal than step tip catheters. FUNDING Grants from government (Queensland Health, Safer Care Victoria, Medical Research Future Fund, National Health and Medical Research Council, Australia), academic (Monash University), and not-for-profit (ANZDATA Registry, Kidney Health Australia) sources. TRIAL REGISTRATION Registered at ANZCTR with study number ACTRN12616000830493. PLAIN-LANGUAGE SUMMARY Central venous catheters are widely used to facilitate vascular access for life-sustaining hemodialysis treatments but often fail due to blood clots or other mechanical problems that impede blood flow. A range of adaptations to the design of tunneled hemodialysis catheters have been developed, but it is unclear which designs have the greatest longevity. We analyzed data from an Australian nationwide cohort of patients who received hemodialysis via a tunneled catheter and found that catheters with a step tip design failed more quickly than those with a symmetrical tip. Split tip catheters performed well but were infrequently used and require further study. Use of symmetrical rather than step tip hemodialysis catheters may reduce mechanical failures and unnecessary procedures for patients.
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Affiliation(s)
- Benjamin Lazarus
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Medicine, Monash University, Clayton, Australia; Department of Nephrology, Monash Health, Clayton, Australia.
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Clayton, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia; Department of Nephrology, Monash Health, Clayton, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Sarah Coggan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nicholas A Gray
- Sunshine Coast University Hospital, Birtinya, Australia; University of the Sunshine Coast, Sippy Downs, Australia
| | - Girish Talaulikar
- Department of Nephrology, Canberra Hospital, Garran, Australia; School of Medicine, Australian National University, Acton, Australia
| | - Sradha Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Prince of Wales Hospital, University of New South Wales, Sydney, Australia
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Fonseca AV, Toledo Barros MG, Baptista-Silva JC, Amorim JE, Vasconcelos V. Interventions for thrombosed haemodialysis arteriovenous fistulas and grafts. Cochrane Database Syst Rev 2024; 2:CD013293. [PMID: 38353936 PMCID: PMC10866196 DOI: 10.1002/14651858.cd013293.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Patients who present with problems with definitive dialysis access (arteriovenous fistula (AVF) or arteriovenous graft (AVG)) become catheter dependent (temporary access), a condition that often carries a higher risk of infections, central venous occlusions and recurrent hospitalisations. For AVG, primary patency rates are reported to be 30% to 90% in patients undergoing thrombectomy or thrombolysis. According to the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines, surgery is preferred when the cause of the thrombosis is a stenosis at the site of the anastomosis in thrombosed AVF. The European Best Practice Guidelines (EBPG) reported that thrombosed AVF may be preferably treated with endovascular techniques, but when the cause of thrombosis is in the anastomosis, surgery provides better results with re-anastomosis. Therefore, there is a need to carry out a systematic review to determine the effectiveness and safety of the intervention for thrombosed fistulae. OBJECTIVES This review aims to establish the efficacy and safety of interventions for failed AVF and AVG in patients receiving haemodialysis (HD). SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 28 January 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Registry Portal (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA The review included randomised controlled trials (RCTs) and quasi-RCTs in people undergoing HD treatment using AVF or AVG presenting with clinical or haemodynamic evidence of thrombosis. Patients had to have used an AVF or AVG at least once. DATA COLLECTION AND ANALYSIS Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Our search strategy identified 14 eligible studies (1176 randomised participants) for inclusion in this review. We included three types of interventions for the treatment of thrombosed AVF and AVG: (1) types of thrombectomy, (2) types of thrombolysis and (3) surgical procedures. Most of the included studies had a high risk of bias due to a poor study design, a low number of patients and industry involvement. Overall, there was insufficient evidence to suggest that a specific intervention was better than another for the outcomes of failure, primary patency at 30 days, technical success and adverse events (both major and minor). Primary patency at 30 days may improve with surgical compared to mechanical thrombectomy (3 studies, 404 participants: RR 1.36, 95% CI 1.07 to 1.67); however, the evidence is very uncertain. Death, access dysfunction, successful dialysis, and SONG (Standards Outcomes in Nephrology) outcomes were rarely reported. The current review is limited by the small number of available studies with a limited number of patients enrolled. Most of the studies included in this review have a high risk of bias and a low or very low certainty of evidence. Further research is required to define the most effective and clinically appropriate technique for access dysfunction. AUTHORS' CONCLUSIONS It remains unclear whether any intervention therapy affects the patency at 30 days or failure in any thrombosed HD AV access (very low certainty of evidence). Future research will very likely change the evidence base. Based on the importance of HD access to these patients, future studies of these interventions among people receiving HD should be a priority.
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Affiliation(s)
- Andre V Fonseca
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcos G Toledo Barros
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Cc Baptista-Silva
- Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jorge E Amorim
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Takahashi R, Yabe H, Ishikawa H, Hibino T, Morishita S, Kono K, Moriyama Y, Yamada T. Factors associated with improved health-related quality of life due to improvements in physical function and dialysis-related symptoms following intradialytic exercise in outpatients undergoing haemodialysis. Qual Life Res 2024:10.1007/s11136-023-03593-w. [PMID: 38253769 DOI: 10.1007/s11136-023-03593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Exercise therapy is a crucial intervention for improving health-related quality of life (HRQOL) in patients undergoing haemodialysis. However, factors that improve HRQOL by improving physical function and dialysis-related symptoms remain unknown. This study aimed to examine the physical function parameters and dialysis-related symptoms that improve HRQOL following intradialytic exercise. METHODS This multicentre cohort study included 596 patients who participated in an intradialytic exercise program three times per week for a period of 6 months, which comprised of stretching and resistance training. EuroQol 5 dimensions 5-level (EQ5D-5L), grip strength, isometric knee extension strength, 10-m walking speed, Short Physical Performance Battery (SPPB), and improvement in dialysis-related symptoms were measured at the baseline and post-intervention. A linear mixed model was used to analyse the effects of improved physical function and dialysis-related symptoms on improvements in EQ5D-5L. RESULTS As a physical function index affecting ΔEQ5D-5L, only SPPB showed a significant increase in ΔEQ5D-5L compared with the non-improved group [difference in ΔEQ5D-5L, 0.05 (0.004 to 0.092) point; p < 0.05]). In addition, dialysis-related symptoms with Improved physical conditions [difference in ΔEQ5D-5L, 0.07 (0.02 to 0.13) point] and an Extended walking distance [difference in ΔEQ5D-5L was 0.07 (0.01 to 0.12) point] significantly influenced ΔEQ5D-5L (p < 0.05, both). CONCLUSIONS The improvements observed in the SPPB scores and self-percieved physical fitness and ambulation range, attributable to intradialytic exercise, may potentially improve HRQOL.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Hideaki Ishikawa
- Department of Internal Medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Zomer B, Ruiter MS, Dekker FW, Goertz EG, de Haan MW, Hemmelder MH, Hiligsmann MJ, Konijn WS, van Loon MM, Maessen JM, Mees BM, Rotmans JI, Schurink GW, Vleugels MJJ, Snoeijs MG. FLOW: Flow dysfunction of hemodialysis vascular access: A randomized controlled trial on the effectiveness of surveillance of arteriovenous fistulas and grafts. J Vasc Access 2024:11297298231212754. [PMID: 38166508 DOI: 10.1177/11297298231212754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION It is assumed that identification and correction of asymptomatic stenoses in the vascular access circuit will prevent thrombosis that would require urgent intervention to continue hemodialysis treatment. However, the evidence base for this assumption is limited. Recent international clinical practice guidelines reach different conclusions on the use of surveillance for vascular access flow dysfunction and recommend further research to inform clinical practice. METHODS The FLOW trial is a double-blind, multicenter, randomized controlled trial with a 1:1 individual participant treatment allocation ratio over two study arms. In the intervention group, only symptomatic vascular access stenoses detected by clinical monitoring are treated, whereas in the comparison group asymptomatic stenoses detected by surveillance using monthly dilution flow measurements are treated as well. Hemodialysis patients with a functional arteriovenous vascular access are enrolled. The primary outcome is the access-related intervention rate that will be analyzed using a general linear model with Poisson distribution. Secondary outcomes include patient satisfaction, access-related serious adverse events, and quality of the surveillance process. A cost effectiveness analysis and budget impact analysis will also be conducted. The study requires 828 patient-years of follow-up in 417 participants to detect a difference of 0.25 access-related interventions per year between study groups. DISCUSSION As one of the largest randomized controlled trials assessing the clinical impact of vascular access surveillance using a strong double-blinded study design, we believe the FLOW trial will provide much-needed evidence to improve vascular access care for hemodialysis patients.
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Affiliation(s)
- Bianca Zomer
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Matthijs S Ruiter
- Kennisinstituut, Federation Medical Specialists, Utrecht, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leids University Medical Centre, Leiden, The Netherlands
| | - Ellen Gd Goertz
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Michiel W de Haan
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Marc Hh Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Mickaël Jc Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Wanda S Konijn
- Nierpatienten Vereniging Nederland, Bussum, The Netherlands
| | - Magda M van Loon
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - José Mc Maessen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Barend Me Mees
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Division of Nephrology, Leids University Medical Centre, Leiden, The Netherlands
| | - Geert Wh Schurink
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Marie-José Jpj Vleugels
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Maarten Gj Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
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Fanelli F, Falcone G, Gabbani G, Annese AL, Gianassi I, Cutruzzulla R, Dervishi E, Cirami L. Multidisciplinary working group: key role for percutaneous endovascular AV fistula program. Point of view. J Nephrol 2024; 37:215-219. [PMID: 37864764 DOI: 10.1007/s40620-023-01778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/03/2023] [Indexed: 10/23/2023]
Abstract
Chronic kidney disease is a progressive condition that affects more than 10% of the general population worldwide. Hemodialysis is the most common therapeutic option for kidney failure, which develops in around one out of 1000 individuals in the general population. Hemodialysis needs a vascular access to connect to the extracorporeal machine. In the last few years percutaneous endovascular arterio-venous fistula technique has been increasingly employed with very promising results. Several advantages have been demonstrated in comparison to the standard surgical creation of an arteriovenous fistula. The percutaneous endovascular arterio-venous fistula technique requires multidisciplinary team work. In our practice, we have organized a multidisciplinary team that includes nephrologists, play a key role, interventional radiologists, vascular surgeons, anesthesiologists, and dialysis nurses. Procedural outcomes and feedback received from patients and family members are evaluated periodically in order to improve results. Nephrologists are involved in each step of the management of the percutaneous endovascular arterio-venous fistula: selection, mapping, creation, and follow up. Patient empowerment, education and involvement is required at each step. A dedicated training program, involving patients and the caregiver team is therefore needed. Additional research is required to confirm the benefit of the multidisciplinary team management in end-stage kidney disease patients.
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Affiliation(s)
- Fabrizio Fanelli
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, L.Go G.A Brambilla 3, Florence, Italy.
| | - G Falcone
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, L.Go G.A Brambilla 3, Florence, Italy
| | - G Gabbani
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, L.Go G.A Brambilla 3, Florence, Italy
| | - A L Annese
- Vascular and Interventional Radiology Department, "Careggi" University Hospital, L.Go G.A Brambilla 3, Florence, Italy
| | - I Gianassi
- Nephrology Dialysis and Transplant Unit, "Careggi" University Hospital, Florence, Italy
| | - R Cutruzzulla
- Nephrology Dialysis and Transplant Unit, "Careggi" University Hospital, Florence, Italy
| | - E Dervishi
- Nephrology Dialysis and Transplant Unit, "Careggi" University Hospital, Florence, Italy
| | - L Cirami
- Nephrology Dialysis and Transplant Unit, "Careggi" University Hospital, Florence, Italy
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Chlorogiannis DD, Bousi SE, Zachiotis M, Chlorogiannis A, Kyriakoulis I, Bellos I. Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis. J Nephrol 2023:10.1007/s40620-023-01814-6. [PMID: 38133741 DOI: 10.1007/s40620-023-01814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Arteriovenous fistula represents the preferred vascular access for patients with kidney failure requiring hemodialysis. Surgeons have traditionally used physical examination to identify the most suitable vessels. This meta-analysis aims to evaluate whether ultrasound mapping should be routinely performed before arteriovenous fistula creation. METHODS Medline, Scopus, Web of Science and CENTRAL were systematically searched from inception to November 1, 2022. Randomized controlled trials and cohort studies comparing routine ultrasound mapping to physical examination in terms of arteriovenous fistula patency were included. Meta-analysis was performed by fitting random-effects models. The study protocol has been prospectively registered in PROSPERO (CRD42023402390). RESULTS Overall, 18 studies were included, comprising 3655 participants. Routine pre-operative ultrasound mapping was associated with significantly lower rates of primary arteriovenous fistula failure (Risk Ratio-RR: 0.56, 95% confidence intervals-CI: 0.37-0.84, low certainty). A significant outcome was observed by separately pooling randomized controlled trials (RR: 0.37, 95% CI: 0.25-0.54). Routine ultrasound mapping was also associated with significantly higher rates of 1-year primary arteriovenous fistula patency (RR: 1.33, 95% CI: 1.19-1.47, moderate certainty). This effect remained significant in the analysis of randomized controlled trials (RR: 1.26, 95% CI: 1.02-1.56). CONCLUSIONS Implementing routine pre-operative ultrasound mapping of vessels is associated with significantly better outcomes in terms of early arteriovenous fistula failure and primary patency rates at 12 months. Further research should confirm the long-term benefits of routine ultrasound examination and evaluate its cost-effectiveness in different populations.
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Affiliation(s)
- David-Dimitris Chlorogiannis
- Department of Research Methodology and Biostatistics, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Stelios-Elion Bousi
- First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Marinos Zachiotis
- First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Anargyros Chlorogiannis
- Department of Health Economics, Policy and Management, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Kyriakoulis
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Bellos
- Department of Nephrology and Renal Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 17, Agiou Thoma Str., 11527, Athens, Greece.
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9
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Duncanson EL, Chur-Hansen A, Le Leu RK, Macauley L, Burke AL, Donnelly FF, Collins KL, McDonald SP, Jesudason S. Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management. Kidney Int Rep 2023; 8:2625-2634. [PMID: 38106606 PMCID: PMC10719600 DOI: 10.1016/j.ekir.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients' experiences of needle-related distress to inform the development of prevention, identification, and management strategies. Methods Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically. Results There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency-the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress). Conclusion Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses' technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.
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Affiliation(s)
- Emily L. Duncanson
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Richard K. Le Leu
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Luke Macauley
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anne L.J. Burke
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Fiona F. Donnelly
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathryn L. Collins
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen P. McDonald
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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10
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Schneider AR, Ravani P, King-Shier KM, Quinn RR, MacRae JM, Love S, Oliver MJ, Hiremath S, James MT, Ortiz M, Manns BR, Elliott MJ. Alignment Among Patient, Caregiver, and Health Care Provider Perspectives on Hemodialysis Vascular Access Decision-Making: A Qualitative Study. Can J Kidney Health Dis 2023; 10:20543581231215858. [PMID: 38033483 PMCID: PMC10685780 DOI: 10.1177/20543581231215858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Updates to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access emphasize the "right access, in the right patient, at the right time, for the right reasons." Although this implies a collaborative approach, little is known about how patients, their caregivers, and health care providers engage in vascular access (VA) decision-making. Objective To explore how the perspectives of patients receiving hemodialysis, their caregivers, and hemodialysis care team align and diverge in relation to VA selection. Design Qualitative descriptive study. Setting Five outpatient hemodialysis centers in Calgary, Alberta. Participants Our purposive sample included 19 patients receiving maintenance hemodialysis, 2 caregivers, and 21 health care providers (7 hemodialysis nurses, 6 VA nurses, and 8 nephrologists). Methods We conducted semi-structured interviews with consenting participants. Using an inductive thematic analysis approach, we coded transcripts in duplicate and characterized themes addressing our research objective. Results While participants across roles shared some perspectives related to VA decision-making, we identified areas where views diverged. Areas of alignment included (1) optimizing patient preparedness-acknowledging decisional readiness and timing, and (2) value placed on trusting relationships with the kidney care team-respecting decisional autonomy with guidance. Perspectives diverged in the following aspects: (1) differing VA priorities and preferences-patients' emphasis on minimizing disruptions to normalcy contrasted with providers' preferences for fistulas and optimizing biomedical parameters of dialysis; (2) influence of personal and peer experience-patients preferred pragmatic, experiential knowledge, whereas providers emphasized informational credibility; and (3) endpoints for VA review-reassessment of VA decisions was prompted by access dissatisfaction for patients and a medical imperative to achieve a functioning access for health care providers. Limitations Participation was limited to individuals comfortable communicating in English and from urban, in-center hemodialysis units. Few informal caregivers of people receiving hemodialysis and younger patients participated in this study. Conclusions Although patients, caregivers, and healthcare providers share perspectives on important aspects of VA decisions, conflicting priorities and preferences may impact the decisional outcome. Findings highlight opportunities to bridge knowledge and readiness gaps and integrate shared decision-making in the VA selection process.
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Affiliation(s)
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kathryn M. King-Shier
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jennifer M. MacRae
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannan Love
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew T. James
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Mia Ortiz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden R. Manns
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Meghan J. Elliott
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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11
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Giannikouris IE, Georgiadis GS, Giannakopoulos T, Passadakis P, Spiliopoulos S. Results of a hemodialysis vascular access routine ultrasound surveillance protocol and frequency of surveillance guided pre-emptive access maintenance interventions. J Vasc Access 2023:11297298231207427. [PMID: 37953744 DOI: 10.1177/11297298231207427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To evaluate the implementation of routine surveillance using ultrasound on hemodialysis vascular access (VA) outcomes and determine the number and frequency of corrective, surveillance-guided procedures performed. METHODS Multicenter, prospective, observational study that includes consecutive hemodialysis patients receiving therapy from native arteriovenous fistulae (AVF) or grafts (AVG). Participants were assigned to a routine VA Color Doppler ultrasound surveillance (DUS) protocol from January 2019 to December 2021. Patients were referred for corrective procedures (endovascular or surgical) based on clinical or DUS findings (pre-emptive procedures; PEP). Primary endpoint was the estimation of primary unassisted (PUP) and secondary patency (SP) rates. Secondary endpoints were the determination of the number and frequency of PEP and VA survival rates. RESULTS In total, 223 patients with 243 VA (192 AVF and 51 AVG) were included. Access PUP and SP rates were 83% and 93% at 12 months, 75% and 88% at 24 months, and 72% and 83% at 36 months follow-up. Autologous fistulae PUP and SP were 89% and 96% at 12 months, 81% and 93% at 24 months, and 80% and 89% at 36 months, respectively. Graft PUP and SP were 56% and 80% at 12 months, 44% and 65% at 24 months, and 39% and 54% at 36 months, respectively. In total, 56 corrective procedures (38/56 PEP; 65.5%) were performed (0.13 procedures/year), of which 34 were in AVF patients (0.09 procedures/year) and 22 in AVG patients (0.40 procedures/year). Overall, 33 VA losses occurred (0.06 failures/year), 17 in AVF (0.04 failures/year), and 16 in AVG patients (0.20 failures/year). CONCLUSION The use of DUS resulted in the timely diagnosis of dysfunction, satisfactory overall VA survival, and patency rates, with a low PEP frequency. Randomized controlled trials are required to establish the value of DUS surveillance on access patency and whether DUS-guided interventions could improve VA outcomes.
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Affiliation(s)
- Ioannis E Giannikouris
- Department of Nephrology and Hemodialysis Unit, Mediterraneo Hospital, Glyfada, Athens, Attika, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, Democritus University of Thrace School of Health Sciences, Alexandroupolis, Thrace, Greece
| | | | - Ploumis Passadakis
- Department of Nephrology, Democritus University of Thrace School of Health Sciences, Alexandroupolis, Thrace, Greece
| | - Stavros Spiliopoulos
- 2nd Radiology Department, Division of Interventional Radiology, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Chaidari, Athens, Attika, Greece
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12
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Alindogan NG, Yuo TH. Challenges to Performance of Clinical Trials on Vascular Access. Kidney360 2023; 4:1632-1636. [PMID: 37856685 PMCID: PMC10695645 DOI: 10.34067/kid.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/19/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Nicole G Alindogan
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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13
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Ng JH, Yang W, Dember LM. Performance Characteristics of Candidate Criteria for Hemodialysis Arteriovenous Fistula Maturation. Clin J Am Soc Nephrol 2023; 18:1321-1332. [PMID: 37553865 PMCID: PMC10578636 DOI: 10.2215/cjn.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Twenty to 60% of newly created hemodialysis arteriovenous fistulas do not mature adequately for use. One barrier to developing interventions to improve fistula outcomes is a lack of standardized criteria for maturation. METHODS Using data from the multicenter, prospective Hemodialysis Fistula Maturation (HFM) Study, we determined sensitivities, specificities, and positive and negative predictive values of multiple candidate maturation criteria using the HFM Study maturation criteria as the reference. We also compared, across the maturation criteria, relationships between maturation and fistula survival using Cox proportional hazards models. RESULTS We included 535 of the 602 HFM Study participants. The median (interquartile range) age was 57 (47-65) years, 70% were men, and 45% were Black participants. Depending on the criterion and time frame for ascertainment (3, 4, 5, 6, or 9 months), sensitivities ranged from 57% to 100%, specificities ranged from 85% to 100%, positive predictive values ranged from 88% to 100%, and negative predictive values ranged from 65% to 100%. For all criteria, areas under the curve for the 6-month (0.90-0.97 for unassisted maturation and 0.89-0.95 for overall maturation) and 9-month time frames were similar. Attainment of unassisted maturation was associated with lower risks of fistula abandonment, with hazard ratios ranging from 0.10 to 0.40 depending on the criterion and time frame. Eliminating dialysis adequacy indicators, or simplifying the criteria in other ways, had little effect on performance characteristics. CONCLUSIONS High performance characteristics are maintained with maturation criteria that are simpler and less burdensome to ascertain than the HFM Study outcome measure.
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Affiliation(s)
- Jia Hwei Ng
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura M. Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Lazarus B, Kotwal S, Gallagher M, Gray NA, Coggan S, Rogers K, Talaulikar G, Polkinghorne KR. Effect of a Multifaceted Intervention on the Incidence of Hemodialysis Catheter Dysfunction in a National Stepped-Wedge Cluster Randomized Trial. Kidney Int Rep 2023; 8:1941-1950. [PMID: 37849996 PMCID: PMC10577327 DOI: 10.1016/j.ekir.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Effective strategies to prevent hemodialysis (HD) catheter dysfunction are lacking and there is wide variation in practice. Methods In this post hoc analysis of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a national (REDUCCTION) stepped-wedge cluster randomized trial, encompassing 37 Australian nephrology services, 6361 participants, and 9872 catheters, we investigated whether the trial intervention, which promoted a suite of evidence-based practices for HD catheter insertion and management, reduced the incidence of catheter dysfunction, which is defined by catheter removal due to inadequate dialysis blood flow. We also analyzed outcomes among tunneled cuffed catheters and sources of event variability. Results A total of 873 HD catheters were removed because of dysfunction over 1.12 million catheter days. The raw incidence was 0.91 events per 1000 catheter days during the baseline phase and 0.68 events per 1000 catheter days during the intervention phase. The service-wide incidence of catheter dysfunction was 33% lower during the intervention after adjustment for calendar time (incidence rate ratio = 0.67; 95% confidence interval [CI], 0.50-0.89; P = 0.006). Results were consistent among tunneled cuffed catheters (adjusted incidence rate ratio = 0.68; 95% CI, 0.49-0.94), which accounted for 75% of catheters (n = 7403), 97.4% of catheter exposure time and 88.2% of events (n = 770). Among tunneled catheters that survived for 6 months (21.5% of tunneled catheters), between 2% and 5% of the unexplained variation in the number of catheter dysfunction events was attributable to service-level differences, and 18% to 36% was attributable to patient-level differences. Conclusion Multifaceted interventions that promote evidence-based catheter care may prevent dysfunction, and patient factors are an important source of variation in events.
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Affiliation(s)
- Benjamin Lazarus
- The George Institute for Global Health, UNSW, Sydney, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Sradha Kotwal
- The George Institute for Global Health, UNSW, Sydney, Australia
- Prince of Wales Hospital, UNSW Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, UNSW, Sydney, Australia
- South Western Sydney Campus, UNSW, Sydney, Australia
| | - Nicholas A. Gray
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Sarah Coggan
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Graduate School of Health, The University of Technology Sydney, Sydney, Australia
| | - Girish Talaulikar
- Department of Nephrology, The Canberra Hospital, Garran, ACT, Australia
- Australian National University School of Medicine, Acton, ACT, Australia
| | - Kevan R. Polkinghorne
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - REDUCCTION Investigators12
- The George Institute for Global Health, UNSW, Sydney, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- Prince of Wales Hospital, UNSW Sydney, Australia
- South Western Sydney Campus, UNSW, Sydney, Australia
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Graduate School of Health, The University of Technology Sydney, Sydney, Australia
- Department of Nephrology, The Canberra Hospital, Garran, ACT, Australia
- Australian National University School of Medicine, Acton, ACT, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
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15
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Titapiccolo JI, Lonati C, Goethel-Paal B, Bello AR, Bellocchio F, Pizzo A, Theodose M, Salvador MEB, Schofield M, Cioffi M, Basnayake K, Chisholm C, Mitrovic S, Trkulja M, Arens HJ, Stuard S, Neri L. Chronic kidney disease-associated pruritus (CKD-aP) is associated with worse quality of life and increased healthcare utilization among dialysis patients. Qual Life Res 2023; 32:2939-2950. [PMID: 37269433 DOI: 10.1007/s11136-023-03438-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Chronic pruritus significantly impairs hemodialysis patients' health status and quality of life (QOL) and it is associated with higher mortality rate, more frequent hospitalizations, poorer dialysis and medication adherence, and deteriorated mental status. However, pruritus is still underestimated, underdiagnosed, and undertreated in the real-life clinical scenario. We investigated prevalence, clinical characteristics, clinical correlates, severity as well as physical and psychological burden of chronic pruritus among adult hemodialysis patients in a large international real-world cohort. METHODS We conducted a retrospective cross-sectional study of patients registered in 152 Fresenius Medical Care (FMC) NephroCare clinics located in Italy, France, Ireland, United Kingdom, and Spain. Demographic and medical data were retrieved from the EuCliD® (European Clinical) database, while information on pruritus and QoL were abstracted from KDQOL™-36 and 5-D Itch questionnaire scores. RESULTS A total of 6221 patients were included, of which 1238 were from France, 163 Ireland, 1469 Italy, 2633 Spain, and 718 UK. The prevalence of mild-to-severe pruritus was 47.9% (n = 2977 patients). Increased pruritus severity was associated with increased use of antidepressants, antihistamines, and gabapentin. Patients with severe pruritus more likely suffered from diabetes, more frequently missed dialysis sessions, and underwent more hospitalizations due to infections. Both mental and physical QOL scores were progressively lower as the severity of pruritus increased; this association was robust to adjustment for potential confounders. CONCLUSION This international real-world analysis confirms that chronic pruritus is a highly prevalent condition among dialysis patients and highlights its considerable burden on several dimensions of patients' life.
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Affiliation(s)
- Jasmine Ion Titapiccolo
- International Data Science-Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, Palazzo Pignano, Italy
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Berit Goethel-Paal
- Global Medical Office, EMEA CoE Clinical & Therapeutical Governance, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Francesco Bellocchio
- International Data Science-Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, Palazzo Pignano, Italy
| | | | | | | | | | | | | | - Chis Chisholm
- Fresenius Medical Care (UK) Ltd., 2HU, Sutton-in-Ashfield, UK
| | - Suzanne Mitrovic
- Nursing Care Care Operations EMEA, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Marjelka Trkulja
- Nursing Care Care Operations EMEA, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Hans-Juergen Arens
- Frenova International Clinical Research Services, Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, EMEA CoE Clinical & Therapeutical Governance, Fresenius Medical Care, Bad Homburg, Germany
| | - Luca Neri
- International Data Science-Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, Palazzo Pignano, Italy.
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16
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Ratnam L, Karunanithy N, Mailli L, Diamantopoulos A, Morgan RA. Dialysis Access Maintenance: Plain Balloon Angioplasty. Cardiovasc Intervent Radiol 2023; 46:1136-1143. [PMID: 37156943 PMCID: PMC10471649 DOI: 10.1007/s00270-023-03441-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
Plain balloon angioplasty remains the first-line treatment for dialysis access stenosis. This chapter reviews the outcomes of plain balloon angioplasty from cohort studies and comparative studies. Angioplasty outcomes are more favourable in arteriovenous fistulae (AVF) compared to arteriovenous grafts (AVG) with primary patency at 6 months ranging from 42-63% compared to 27-61%, respectively, and improved for forearm fistulae compared with upper arm fistulae. Higher pressures are required to treat stenoses in AVFs compared to AVGs. Outcomes are worse in more severe stenoses, increased patient age, previous interventions and fistulae that develop early stenoses. Major complication rates following angioplasty in dialysis access are between 3 and 5%. Repeat treatments and the use of adjuncts such as drug-coated balloons and stents can prolong the patency of dialysis access. Level of Evidence No level of evidence (Review paper).
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Affiliation(s)
- Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK.
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Leto Mailli
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Robert A Morgan
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
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17
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Zhou G, Chen Y, Chien C, Revatta L, Ferdous J, Chen M, Deb S, De Leon Cruz S, Wang A, Lee B, Sabuncu MR, Browne W, Wun H, Mosadegh B. Deep learning analysis of blood flow sounds to detect arteriovenous fistula stenosis. NPJ Digit Med 2023; 6:163. [PMID: 37658233 PMCID: PMC10474109 DOI: 10.1038/s41746-023-00894-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023] Open
Abstract
For hemodialysis patients, arteriovenous fistula (AVF) patency determines whether adequate hemofiltration can be achieved, and directly influences clinical outcomes. Here, we report the development and performance of a deep learning model for automated AVF stenosis screening based on the sound of AVF blood flow using supervised learning with data validated by ultrasound. We demonstrate the importance of contextualizing the sound with location metadata as the characteristics of the blood flow sound varies significantly along the AVF. We found the best model to be a vision transformer trained on spectrogram images. Our model can screen for stenosis at a performance level comparable to that of a nephrologist performing a physical exam, but with the advantage of being automated and scalable. In a high-volume, resource-limited clinical setting, automated AVF stenosis screening can help ensure patient safety via early detection of at-risk vascular access, streamline the dialysis workflow, and serve as a patient-facing tool to allow for at-home, self-screening.
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Affiliation(s)
- George Zhou
- Weill Cornell Medicine, New York, NY, 10021, USA.
| | - Yunchan Chen
- Weill Cornell Medicine, New York, NY, 10021, USA
| | | | - Leslie Revatta
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Jannatul Ferdous
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Michelle Chen
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Shourov Deb
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Sol De Leon Cruz
- City University of New York, Hunter College, New York, NY, 10021, USA
| | - Alan Wang
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
| | - Benjamin Lee
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Mert R Sabuncu
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, NY, 10044, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - William Browne
- Department of Interventional Radiology, NewYork-Presbyterian Hospital, New York, NY, 10021, USA
| | - Herrick Wun
- Department of Vascular Surgery, NewYork-Presbyterian Hospital, New York, NY, 10021, USA.
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA.
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18
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Richarz S, Greenwood S, Kingsmore DB, Thomson PC, Dunlop M, Bouamrane MM, Meiklem R, Stevenson K. Validation of a vascular access specific quality of life measure (VASQoL). J Vasc Access 2023; 24:702-714. [PMID: 34608832 DOI: 10.1177/11297298211046746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A self-administered 11 item vascular access specific quality of life measure (VASQoL) was previously derived from detailed qualitative interviews with adult patients with kidney failure who have experienced vascular access using the Capabilities Approach as a theoretical base. This study reports the psychometric validation of the VASQoL measure including its reliability, content validity and responsiveness to change. METHODS Cognitive interviews were conducted with 23 adult patients with kidney failure after completion of the VASQoL measure. Focus group discussion with a vascular access professional multidisciplinary team was undertaken (n = 8) and subsequently a further 101 adult kidney failure patients with vascular access (TCVC, AVF or AVG) completed the digital VASQoL measure, EQ-5D and SF-36 questionnaires in a longitudinal study with prospectively recorded vascular access events. RESULTS Transcript analysis of cognitive interviews after VASQoL completion indicated that the content was comprehensive and well understood by participants. Assessment of Internal reliability for the VASQoL measure was high (Cronbach's alpha 0.858). Test-retest reliability of the overall VASQoL measure was high (intra class correlation coefficient 0.916). In those patients who experienced a vascular access event, significant differences were observed in paired analysis of the VASQoL physical domain questions and vascular access function domain questions and in the EQ-5D usual activities, pain and anxiety domains. In those with no vascular access event, variation was observed in longitudinal analysis in VASQoL questions relating to worry about VA function and capability domains, whilst no variation was observed in the EQ5D measure. CONCLUSION The VASQoL measure has good internal consistency, test-retest reliability, convergent validity and responsiveness to change for clinically relevant vascular access outcomes. This provides a validated, vascular access specific quality of life measure that can be used in future trials of vascular access, evaluation of new technologies and routine use as a patient reported outcome measure (PROM).
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Affiliation(s)
- Sabine Richarz
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Department of Vascular Surgery and Renal Transplantation, University Hospital Basel, Basel, Switzerland
| | - Sharon Greenwood
- Graduate School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - David B Kingsmore
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Peter C Thomson
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Ramsey Meiklem
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Karen Stevenson
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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19
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Schneditz D, Ribitsch W, Keane DF. Intradialytic techniques for automatic and everyday access monitoring. Semin Dial 2023. [PMID: 37368415 DOI: 10.1111/sdi.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Vascular access dysfunction is associated with reduced delivery of dialysis, unplanned admissions, patient symptoms, and loss of access, making assessment of vascular access a fundamental part of routine care in dialysis. Clinical trials to predict the risk of access thrombosis based on accepted reference methods of access performance have been disappointing. Reference methods are time-consuming, affect the delivery of dialysis, and therefore cannot repeatedly be used with every dialysis session. There is now a new focus on data continuously and regularly collected with every dialysis treatment, directly or indirectly associated with access function, and without interrupting or affecting the delivered dose of dialysis. This narrative review will focus on techniques that can be used continuously or intermittently during dialysis, taking advantage of methods integrated into the dialysis machine and which do not affect the delivery of dialysis. Examples include extracorporeal blood flow, dynamic line pressures, effective clearance, dose of delivered dialysis, and recirculation which are all routinely measured on most modern dialysis machines. Integrated information collected throughout every dialysis session and analyzed by expert systems and machine learning has the potential to improve the identification of accesses at risk of thrombosis.
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Affiliation(s)
- Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David F Keane
- CÚRAM Science Foundation Ireland, Research Centre for Medical Devices, Health Research Board, Clinical Research Facility Galway, University of Galway, Galway, Ireland
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20
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Prabhakaran M, Mahapatra HS, Nath RK, Pursnani L, Balakrishnan M, Singh A, Singh A, Patil S, Gautam A. Comparison of clinical examination, doppler and fistulogram for arterio-venous fistula surveillance in detecting secondary failure. J Vasc Access 2023:11297298231161461. [PMID: 37318136 DOI: 10.1177/11297298231161461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Arteriovenous Fistula (AVF) surveillance is required to detect early dysfunction (thrombosis, stenosis) and its timely correction prolongs access-patency. Clinical examination (CE) and doppler have been used as screening/surveillance of AVF, for early detection of AVF dysfunction. Since there was inadequate evidence for KDOQI to make recommendations on AVF surveillance and on secondary failure rate. We compared CE, doppler and fistulogram as surveillance modalities in detecting a secondary failure in matured AVF. METHODOLOGY This prospective-observational, single-center study, was done between December 2019-April 2021. CKD stage 5 patients on dialysis/Not-on-dialysis with matured AVF were included at third month. CE, doppler (blood flow, vein diameter, depth), and fistulogram were done at third and sixth month. Secondary failure was assessed at sixth month classifying AVF to patent/functional and failed group. Diagnostic tests were performed by comparing three methods considering fistulogram as gold-standard. Residual urine output is also monitored to look for any contrast induced residual renal function loss. RESULTS Of total 407 created AVF, 98 (24%) had primary failure. Twenty-five (6%) had surgical complications including unsuccessful AVF and aneurysm/rupture, 156 lost follow-up at third month, 104 consented patients were enrolled, 16 lost to follow-up subsequently, and 88 patients' data were analyzed at the end. At the sixth month, 76(86.4%) had patent AVF, 8 (9.1%) had secondary failure (Thrombosis-4, Central Venous Stenosis-4), and 4 (4.1%) patients expired. Considering fistulogram as a diagnostic standard, CE showed 87.5% sensitivity, and 93.4% specificity (cohen's kappa value of 0.66). Doppler had sensitivity and specificity of 87% and 96% respectively (cohen's kappa value of 0.75), Combination of clinical examination with doppler showed sensitivity and specificity of 100% and 89% respectively. CONCLUSION Although the secondary AVF failure rate is less than the primary, CE is an important and valuable tool in the diagnosis and surveillance of AVF in detecting its dysfunction. Moreover, CE with doppler can be used as a surveillance protocol that can detect early AVF dysfunction at par with Fistulogram.
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Affiliation(s)
- Manoj Prabhakaran
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Ranjith Kumar Nath
- Department of Cardiology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lalit Pursnani
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Anamika Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amandeep Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sanket Patil
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhisek Gautam
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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21
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Grandinetti A, Hilliard-Boone TS, Wilund KR, Logan D, St Peter WL, Wingard R, Tentori F, Keller S, West M, Lacson Jr E, Richardson MM. Patient Perspectives of Skeletal Muscle Cramping in Dialysis: A Focus Group Study. Kidney360 2023; 4:e734-e743. [PMID: 37036682 PMCID: PMC10371365 DOI: 10.34067/kid.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
Key Points This first step demonstrated content validity for a patient-reported outcome measure for skeletal muscle cramping in dialysis. This work lays the foundation for developing a patient-reported outcome measure for regulatory use to assess skeletal muscle cramping in people receiving dialysis. Background Skeletal muscle cramping is a common, painful, and debilitating symptom experienced by people receiving dialysis. Neither a standardized, patient-endorsed definition of skeletal muscle cramping nor full understanding of patients' perspectives of skeletal muscle cramping exist. We conducted focus groups, within a Kidney Health Initiative (KHI) project, to elicit skeletal muscle cramping experiences of people receiving dialysis as the basis for patient-reported outcome measure (PROM) development. Methods Eligible participants (English-speaking adults aged 18–85 years treated by dialysis and a skeletal muscle cramping episode within 30 days) were purposively recruited from a panel (L&E Research) of people receiving dialysis at home or in-center. Standard qualitative methods were used to conduct virtual 90-minute sessions discussing the following: skeletal muscle cramping clinical characteristics, participants' skeletal muscle cramping experiences, and feedback on a draft skeletal muscle cramping definition and a patient-facing conceptual model developed by the KHI project workgroup. We used qualitative thematic analysis. Results There were 20 diverse participants in three focus groups. Universally experienced skeletal muscle cramping attributes differed by dialysis setting in onset, worst pain rating, duration, and timing. Variably experienced attributes (applied to home and in-center dialysis) were gross and fine motor effect, sleep disruption, mood-related themes of fear, and annoyance/frustration/irritability. Avoidance/adaptive behaviors included reluctance or avoiding movement, adjusting what they ate or drink (e.g. , yellow mustard, pickles, pickle juice, and tonic water), heat application, massage, and cannabidiol use. The skeletal muscle cramping definition was endorsed, and insightful suggestions for conceptual model were collected. Conclusions This qualitative study of in-center and home patients' skeletal muscle cramping experiences identified universally and variably experienced attributes. The patient-endorsed skeletal muscle cramping definition can serve as a standard for assessment. These results provide the foundation to develop a PROM for regulatory use with people receiving maintenance dialysis who experience skeletal muscle cramping.
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Affiliation(s)
- Amanda Grandinetti
- Kidney Health Initiative Patient and Family Partnership Council, Washington, District of Columbia
| | | | - Kenneth R. Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Dilani Logan
- American Institutes for Research, Health, Oakland, California
| | | | - Rebecca Wingard
- Fresenius Medical Care North America, Clinical Services, Waltham, Massachusetts
| | | | - San Keller
- American Institutes for Research, Health, Chapel Hill, North Carolina
| | - Melissa West
- American Society of Nephrology, Washington, District of Columbia
| | - Eduardo Lacson Jr
- Dialysis Clinic, Inc., Nashville, Tennessee
- Tufts Medical Center, Boston, Massachusetts
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22
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Kingsmore DB, Stevenson KS, Thomson PC, Kasthuri R, Knight S, Jackson A, Hussey K, Richarz S, Isaak A. Pre-emptive or reactive treatment, angioplasty or stent-graft? The outcome for interventions for venous stenosis in early-cannulation arteriovenous grafts. J Vasc Access 2023; 24:253-260. [PMID: 34219517 DOI: 10.1177/11297298211029413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early-cannulation arteriovenous grafts (ecAVG) have good initial patency, but frequent episodes of reintervention for venous stenosis (VS) and thrombosis limit their use. Stent grafts (SG) have shown promise in reducing re-interventions and improving functional patency for dysfunctional ecAVG and recurrent VS. There is little data on the impact of stent grafts as the first elective procedure for VS. The aim of this study was to determine firstly, if treating VS whilst asymptomatic has a better outcome than treating after presentation with thrombosis; and secondly, to determine the best initial treatment for asymptomatic VS: SG or angioplasty. METHODS A retrospective study was performed of 259 ecAVG with a sutured anastomosis. The case-mix and outcomes of 153 who presented with VS was analysed by presentation (elective at surveillance or emergency following thrombosis), and then for only elective patients, by treatment (SG vs angioplasty). RESULTS There was no significant difference in case-mix and time to presentation by mode of presentation (100 elective and 53 with thrombosis) other than a higher rate of pro-thrombotic disorders in thrombosed ecAVG. Thrombosed ecAVG had poorer outcomes with increased re-intervention rates and thrombosis in the following year, and reduced long-term functional patency. In patients presenting electively, primary SG rather than angioplasty led to significantly reduced thrombosis rates, a longer time to re-intervention in the following year, and superior long-term functional patency. The use of SG was the same in both groups. Both the mode of presentation and the type of intervention performed were independently predictive of a poorer subsequent functional patency. CONCLUSIONS Primary elective stent-grafting may be the optimal strategy to reducing maintenance costs with ecAVG.
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Affiliation(s)
- David B Kingsmore
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Vascular and Endovascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Karen S Stevenson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Peter C Thomson
- Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Stephen Knight
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith Hussey
- Vascular and Endovascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabine Richarz
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Vascular and Endovascular Surgery, University Hospital, Aarau-Basel, Switzerland
| | - Andrej Isaak
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Vascular and Endovascular Surgery, University Hospital, Aarau-Basel, Switzerland
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23
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Viecelli AK, Teixeira-Pinto A, Valks A, Baer R, Cherian R, Cippà PE, Craig JC, DeSilva R, Jaure A, Johnson DW, Kiriwandeniya C, Kopperschmidt P, Liu WJ, Lee T, Lok C, Madhan K, Mallard AR, Oliver V, Polkinghorne KR, Quinn RR, Reidlinger D, Roberts M, Sautenet B, Hooi LS, Smith R, Snoeijs M, Tordoir J, Vachharajani TJ, Vanholder R, Vergara LA, Wilkie M, Yang B, Yuo TH, Zou L, Hawley CM. Study protocol for Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID). BMC Nephrol 2022; 23:372. [PMCID: PMC9675211 DOI: 10.1186/s12882-022-02987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative. Methods VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors. Discussion Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care. Trial registration Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02987-1.
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Affiliation(s)
- Andrea K. Viecelli
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102 Australia ,grid.489335.00000000406180938The Translational Research Institute, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Armando Teixeira-Pinto
- grid.1013.30000 0004 1936 834XCentre for Kidney Research, School of Public Health, The University of Sydney, Sydney, Australia
| | - Andrea Valks
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Richard Baer
- grid.416528.c0000 0004 0637 701XMater Hospital Brisbane, Brisbane, Queensland Australia
| | - Roy Cherian
- grid.460765.60000 0004 0430 0107Mackay Base Hospital, Mackay, Australia
| | - Pietro E. Cippà
- grid.469433.f0000 0004 0514 7845Division of Nephrology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Jonathan C. Craig
- grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - Ranil DeSilva
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh, Pittsburgh, PA USA
| | - Allison Jaure
- grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney, Australia
| | - David W. Johnson
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102 Australia ,grid.489335.00000000406180938The Translational Research Institute, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Charani Kiriwandeniya
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | | | - Wen-J Liu
- grid.413461.50000 0004 0621 7083Sultanah Aminah, Johor Bahru, Malaysia
| | - Timmy Lee
- grid.280808.a0000 0004 0419 1326Veterans Affairs Medical Center, Birmingham, AL USA
| | - Charmaine Lok
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Ontario Canada
| | | | - Alistair R. Mallard
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Veronica Oliver
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102 Australia
| | - Kevan R. Polkinghorne
- grid.416060.50000 0004 0390 1496Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, Monash University, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology & Preventive Medicine, Monash University, Clayton, VIC Australia
| | - Rob R. Quinn
- grid.22072.350000 0004 1936 7697Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Donna Reidlinger
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Matthew Roberts
- grid.1002.30000 0004 1936 7857Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Lai Seong Hooi
- grid.413461.50000 0004 0621 7083Sultanah Aminah, Johor Bahru, Malaysia
| | - Rob Smith
- grid.240634.70000 0000 8966 2764Patient Partner, Royal Darwin Hospital, Darwin, Australia
| | - Maarten Snoeijs
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Tordoir
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, Netherlands
| | - Tushar J. Vachharajani
- grid.239578.20000 0001 0675 4725Department of Kidney Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA ,grid.254293.b0000 0004 0435 0569Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
| | | | - Liza A. Vergara
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Martin Wilkie
- grid.31410.370000 0000 9422 8284Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bing Yang
- grid.411634.50000 0004 0632 4559Peking University People’s Hospital, Beijing, China
| | - Theodore H. Yuo
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh, Pittsburgh, PA USA
| | - Li Zou
- grid.411634.50000 0004 0632 4559Peking University People’s Hospital, Beijing, China
| | - Carmel M. Hawley
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102 Australia ,grid.489335.00000000406180938The Translational Research Institute, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
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Watnick S, Butler CR. Difelikefalin: A Novel Therapy for Dialysis Patient Care. Kidney Med 2022; 4:100519. [PMID: 35991692 PMCID: PMC9386091 DOI: 10.1016/j.xkme.2022.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings. This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement. Nearly 4 million people in the world are living on kidney replacement therapy (KRT), and haemodialysis (HD) remains the commonest form of KRT, accounting for approximately 69% of all KRT and 89% of all dialysis. Dialysis technology and patient access to KRT have advanced substantially since the 1960s, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes continue to vary widely across countries, particularly among disadvantaged populations (including Indigenous peoples, women and people at the extremes of age). Cardiovascular disease affects over two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality; mortality among patients on HD is significantly higher than that of their counterparts in the general population, and treated kidney failure has a higher mortality than many types of cancer. Patients on HD also experience high burdens of symptoms, poor quality of life and financial difficulties. Careful monitoring of the outcomes of patients on HD is essential to develop effective strategies for risk reduction. Outcome measures are highly variable across regions, countries, centres and segments of the population. Establishing kidney registries that collect a variety of clinical and patient-reported outcomes using harmonized definitions is therefore crucial. Evaluation of HD outcomes should include the impact on family and friends, and personal finances, and should examine inequities in disadvantaged populations, who comprise a large proportion of the HD population.
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26
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Heggen BD, Ramspek CL, van der Bogt KEA, de Haan MW, Hemmelder MH, Hiligsmann MJC, van Loon MM, Rotmans JI, Tordoir JHM, Dekker FW, Schurink GWH, Snoeijs MGJ. Optimising Access Surgery in Senior Haemodialysis Patients (OASIS): study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e053108. [PMID: 35115352 PMCID: PMC8814743 DOI: 10.1136/bmjopen-2021-053108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Current evidence on vascular access strategies for haemodialysis patients is based on observational studies that are at high risk of selection bias. For elderly patients, autologous arteriovenous fistulas that are typically created in usual care may not be the best option because a significant proportion of fistulas either fail to mature or remain unused. In addition, long-term complications associated with arteriovenous grafts and central venous catheters may be less relevant when considering the limited life expectancy of these patients. Therefore, we designed the Optimising Access Surgery in Senior Haemodialysis Patients (OASIS) trial to determine the best strategy for vascular access creation in elderly haemodialysis patients. METHODS AND ANALYSIS OASIS is a multicentre randomised controlled trial with an equal participant allocation in three treatment arms. Patients aged 70 years or older who are expected to initiate haemodialysis treatment in the next 6 months or who have started haemodialysis urgently with a catheter will be enrolled. To detect and exclude patients with an unusually long life expectancy, we will use a previously published mortality prediction model after external validation. Participants allocated to the usual care arm will be treated according to current guidelines on vascular access creation and will undergo fistula creation. Participants allocated to one of the two intervention arms will undergo graft placement or catheter insertion. The primary outcome is the number of access-related interventions required for each patient-year of haemodialysis treatment. We will enrol 195 patients to have sufficient statistical power to detect an absolute decrease of 0.80 interventions per year. ETHICS AND DISSEMINATION Because of clinical equipoise, we believe it is justified to randomly allocate elderly patients to the different vascular access strategies. The study was approved by an accredited medical ethics review committee. The results will be disseminated through peer-reviewed publications and will be implemented in clinical practice guidelines. TRIAL REGISTRATION NUMBER NL7933. PROTOCOL VERSION AND DATE V.5, 25 February 2021.
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Affiliation(s)
- Boudewijn Dc Heggen
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Koen E A van der Bogt
- Department of Surgery, Haaglanden Medical Centre, The Hague, Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Michiel W de Haan
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Mickaël J C Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Magda M van Loon
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan H M Tordoir
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Geert Willem H Schurink
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Maarten G J Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
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27
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Abstract
Shared decision-making (SDM) is a process of collaborative deliberation in the dyadic patient-physician interaction whereby physicians inform the patients about the pros and cons of all available treatment options and reach an agreement with the patients on their preferred treatment plan. In hemodialysis vascular access practice, SDM advocates a deliberative approach based on the existence of reasonable alternatives-that is, arteriovenous fistula, arteriovenous graft, and central venous catheter-so that patients are able to form and share preferences about access options. In spite of its ethical imperative, SDM is not broadly applied in hemodialysis vascular access planning. Physicians and surgeons commonly deliver prescriptive fistula-centered recommendations concerning the approach to vascular access care. This paternalistic approach has been shaped by directions from long-held clinical practice guidelines and is reinforced by financial payment models linked with the prevalence of arteriovenous fistula in patients on hemodialysis. Awareness is growing that what may have initially seemed a medically and surgically appropriate approach might not always be focused on each individual's goals of care. Clinician's recommendations for vascular access often do not sufficiently consider the uncertainty surrounding the potential benefits of the decision or the cumulative impact of the decision on patient's quality of life. In the evolving health care landscape, it is time for the practice of hemodialysis vascular access to shift from a hierarchical doctor-patient approach to patient-centered care. In this article we review the current state of vascular access practice, present arguments why SDM is necessary in vascular access planning, review barriers and potential solutions to SDM implementation, and discuss future research contingent on an effective system of physician-patient participative decision-making in hemodialysis vascular access practice.
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Affiliation(s)
- Mariana Murea
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Carl R Grey
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Charmaine E Lok
- Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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28
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Hajibandeh S, Burton H, Gleed P, Hajibandeh S, Wilmink T. Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis. Vascular 2021; 30:1021-1033. [PMID: 34461784 DOI: 10.1177/17085381211041473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients. METHODS We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5 years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival. RESULTS We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF (n = 95,143) or AVG (n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1 year (OR: 1.91, p < .00001), at 2 years (OR: 2.52, p < .00001) and at 5 years (OR: 2.59, p < .00001); and primary-assisted patency at 1 year (OR: 1.71, p < .00001), at 2 years (OR: 2.13, p < .00001) and 5 years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1 year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2 years (OR: 1.26, p < .00001) and 5 years (OR: 1.60, p < .00001) than AVG. CONCLUSIONS The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5 years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.
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Affiliation(s)
- Shahin Hajibandeh
- Department of General Surgery, Hereford County Hospital, 8947Wye Valley NHS Trust, Hereford, UK
| | - Hannah Burton
- Department of Vascular Surgery, 159028Royal Devon and Exeter Hospital, Exeter, UK
| | - Philippa Gleed
- Department of Vascular Surgery, 159028Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Teun Wilmink
- Department of Vascular Surgery, 159028Royal Devon and Exeter Hospital, Exeter, UK
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Anderson NE, McMullan C, Calvert M, Dutton M, Cockwell P, Aiyegbusi OL, Kyte D. Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study. BMJ Open 2021; 11:e052629. [PMID: 34446501 PMCID: PMC8395280 DOI: 10.1136/bmjopen-2021-052629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Patients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs) may help support tailored healthcare and improve outcomes. This study investigates the methodological basis for routine PRO assessment, particularly using electronic formats (ePROs), to maximise the potential of PRO use, through exploration of the experiences, views and perceptions of patients and healthcare professionals (HCPs) on implementation and use of PROs in haemodialysis settings. STUDY DESIGN Qualitative study. SETTING AND PARTICIPANTS Semistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK. ANALYTICAL APPROACH Transcripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis. RESULTS For effective implementation, the potential value of PROs needs to be demonstrated empirically to stakeholders. Any intervention must remain flexible enough for individual and aggregate use, measuring outcomes that matter to patients and clinicians, while maintaining operational simplicity. Any implementation must sit within a wider framework of education and support for both patients and clinicians who demonstrate varying previous experience of using PROs and often confuse related concepts. Implementation plans must recognise the multidimensionality of end-stage kidney disease and treatment by haemodialysis, while acknowledging the associated challenges of delivering care in a highly specialised environment. To support implementation, careful consideration needs to be given to barriers and facilitators including effective leadership, the role of champions, effective launch and ongoing evaluation. CONCLUSIONS Using the CFIR to explore the experiences, views and perceptions of key stakeholders, this study identified key factors at organisational and individual levels which could assist effective implementation of ePROs in haemodialysis settings. Further research will be required to evaluate subsequent ePRO interventions to demonstrate the impact and benefit to the dialysis community.
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Affiliation(s)
- Nicola Elzabeth Anderson
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
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30
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Coventry LL, Hosking J, Coral E, Jenkins M, Salgado Kent CP, Chan D, Lim W, Twigg DE, Rickard CM. The development of the Western Australian Haemodialysis Vascular Access Complexity instrument. J Ren Care 2021; 48:185-196. [PMID: 34181822 PMCID: PMC9543205 DOI: 10.1111/jorc.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Background The Western Australian Haemodialysis Vascular Access Classification instrument was developed to classify the cannulation complexity of the arteriovenous fistula or arteriovenous graft as simple, challenging, or complex. Although the instrument was developed by experts in haemodialysis nursing, the instrument had not undergone formal validity or reliability testing. Objectives Evaluate the Western Australian Haemodialysis Vascular Access Classification instrument for content validity, interrater and test–retest reliability. Design Prospective cohort study. Participants Content validity was assessed by haemodialysis nursing experts (n = 8). The reliability testing occurred in one in‐centre and one satellite haemodialysis unit in Western Australia from September to November 2019. Reliability testing was performed by 38 haemodialysis nurses in 67 patients receiving haemodialysis and 247 episodes of cannulation. Measurements Interrater and test–retest reliability assessment was conducted using κ, adjusted κ, Bland–Altman plots, intraclass correlation coefficient and Pearson's correlation coefficient. Results The final version of the instrument (n = 20 items) had individual item‐level content validity indices ranging from 0.625 to 1.00 with a scale‐level content validity index of 0.89. For both interrater (n = 172 pairs) and test–retest (n = 101 pairs), most individual variables had excellent adjusted κ (n = 33 variables), some fair to good agreement (n = 6 variables) and one variable with poor agreement. The classification of simple, challenging and complex demonstrated adjusted κ of fair to good, to excellent agreement for interrater reliability with lower levels of agreement for test–retest reliability. Conclusions This instrument may be used to match a competency‐assessed nurse to perform the cannulation thereby minimising the risk of missed cannulation and trauma.
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Affiliation(s)
- Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Jon Hosking
- Renal Services, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
| | - Evelyn Coral
- Haemodialysis Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mark Jenkins
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Chandra P Salgado Kent
- Centre for Marine Ecosystems Research, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Doris Chan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Wai Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Diane E Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Southport, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Chan S, Au E, Johnson DW, Hawley CM, Tong A, Pascoe EM, Craig JC, Sautenet B, Blumberg EA, Brennan D, Campbell SB, Cao C, Francis RS, Huuskes B, Isbel NM, Knoll G, Kotton CN, Mamode N, Muller E, Ha Phan HA, Tedesco-Silva H, White DM, Wolley MJ, Viecelli AK. Range and Consistency of Infection Outcomes Reported in Trials Conducted in Kidney Transplant Recipients: a Systematic Review. Transplantation 2021. [PMID: 33653998 DOI: 10.1097/TP.0000000000003723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection remains a leading cause of death in kidney transplant recipients. This study aimed to assess the scope and consistency of infection outcomes reported in contemporary trials conducted in kidney transplant recipients. METHODS A literature review of all randomized trials and trial protocols reporting infection outcomes in adult kidney transplant recipients were identified in the Cochrane Kidney and Transplant Specialized Register from January 2014 to July 2019. Characteristics and infection outcomes from the trials were analyzed. RESULTS From 102 included trials, 772 outcome measures were extracted and categorized into 216 unique measures with a median of 3.2 outcome measures per trial (range: 1 to 9). Measures were further grouped into 32 outcomes based on site of infection (14 outcomes) and organism (18 outcomes). The most commonly reported site-specific outcome and organism-specific outcome was systemic infection (71% trials) and cytomegalovirus infection (62% trials), respectively. Outcome metric and methods of aggregation included mean, median, proportion, proportional change and number of patients with at least 1 episode. Across all trials, measures were assessed at 55 different time points with a range of 1 to 11 time points per trial. CONCLUSIONS Infection outcomes in kidney transplant recipients were frequently reported by site and organism but varied widely in terms of outcome, metrics, method of aggregation and time point of measurement. Establishment of core outcomes for infection based on the shared priorities of patients/caregivers and health professionals may improve the consistency, comparability and usefulness of trial evidence.Supplemental Visual Abstract; http://links.lww.com/TP/C169.
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Fielding CA, Hadfield A, White K, Waters D, James C, Buchanan H, Fluck RJ, Selby NM. A narrative systematic review of randomised controlled trials that compare cannulation techniques for haemodialysis. J Vasc Access 2021; 23:212-224. [PMID: 33427013 DOI: 10.1177/1129729820983174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cannulation of arteriovenous access for haemodialysis affects longevity of the access, associates with complications and affects patients' experiences of haemodialysis. Buttonhole and rope ladder techniques were developed to reduce complications. However, studies that compare these two techniques report disparate results. This systematic review performs an in-depth exploration of RCTs, with a specific focus on cannulation as a complex intervention. METHODS A PICO question and protocol was developed as per PRISMA-P guidance and registered on PROSPERO (CRD42018094656 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=112895). The systematic review included any RCT performed on adult patients with end-stage kidney disease undergoing cannulation of arteriovenous fistulae or grafts for in-centre haemodialysis, as performed by healthcare staff. Assessment of quality of RCTs and data extraction were performed by two co-authors independently. Data were extracted on the study design, intervention and comparator and outcomes, including patency, infection and patients' experiences. RESULTS The literature search identified 241 records. Ten records met inclusion criteria, which described five different RCTs that compared buttonhole to either rope ladder or usual practice. Results were disparate, with patency and infection results varying. Pain Visual Analogue scores were the only measure used to capture patients' experiences and results were inconclusive. All RCTs had differences and limitations in study design that could explain the disparity in results. CONCLUSION Current evidence does not allow definitive conclusions as to whether buttonhole or rope ladder needling technique is superior. Future RCTs should describe interventions and comparators with adequate detail, embed process evaluation, use standardised outcome measures and build on feasibility studies to produce definitive results.
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Affiliation(s)
- Catherine A Fielding
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,UK Renal Registry, Bristol, UK
| | - Amanda Hadfield
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Kelly White
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Dan Waters
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Cathryn James
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Richard J Fluck
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nicholas M Selby
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.,University of Nottingham, Nottingham, UK
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De Silva I, Evangelidis N, Hanson CS, Manera K, Guha C, Scholes-Robertson N, Craig JC, Johnson D, Cho Y, Viecelli AK, Tong A. Patient and caregiver perspectives on sleep in dialysis. J Sleep Res 2020; 30:e13221. [PMID: 33103303 DOI: 10.1111/jsr.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances are common among patients receiving dialysis and are associated with an increased risk of mortality and morbidity, and impaired quality of life. Despite being highly prioritised by patients, sleep problems remain under-diagnosed and inadequately managed. The aim of the present study was to describe the perspectives of patients receiving dialysis and their caregivers on sleep. We extracted qualitative data on sleep from 26 focus groups, two international Delphi surveys, and two consensus workshops involving 644 patients and caregivers from 86 countries as part of the Standardised Outcomes in Nephrology-Haemodialysis and -Peritoneal Dialysis (SONG-HD/SONG-PD) initiatives. The responses were from patients aged ≥18 years receiving haemodialysis or peritoneal dialysis, and their caregivers. We analysed the data using thematic analysis with five themes identified: constraining daily living (with subthemes of: battling intrusive tiredness, exacerbating debilitating conditions, broken and incapacitated); roadblocks in relationships (unable to meet family needs, antipathy due to misunderstanding, wreaking emotional havoc); burden on caregivers (stress on support persons, remaining alert to help); losing enjoyment (limiting social contact, disempowerment in life); and undermining mental resilience (aggravating low mood, diminishing coping skills, reducing functional ability). Sleep disturbances are exhausting for patients on dialysis and pervade all aspects of their lives including the ability to do daily tasks, and maintaining relationships, mental and emotional well-being. Better assessment and management of sleep problems in dialysis is needed, which may lead to improvements in overall health and quality of life.
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Affiliation(s)
- Iresha De Silva
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Community Paediatrics, Liverpool Community Health Centre, Liverpool, NSW, Australia
| | - Nicole Evangelidis
- 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
| | - Camilla S Hanson
- 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
| | - Karine Manera
- 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
| | - Chandana Guha
- 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
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Yeoungiee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, 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.,Translational Research Institute, Brisbane, QLD, Australia
| | - 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
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Sylvestre R, Alencar de Pinho N, Massy ZA, Jacquelinet C, Prezelin-Reydit M, Galland R, Stengel B, Coscas R. Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation. BMC Nephrol 2020; 21:422. [PMID: 33008322 PMCID: PMC7532567 DOI: 10.1186/s12882-020-02080-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis access and how they relate with outcomes in adults wait-listed early for KT according to the intended donor source. METHODS This study from the REIN registry (2002-2014) included 9331 incident dialysis patients (age 18-69) wait-listed for KT before or by 6 months after starting dialysis: 8342 candidates for deceased-donor KT and 989 for living-donor KT. Subdistribution hazard ratios (SHR) of KT and death associated with hemodialysis by catheter or peritoneal dialysis compared with arteriovenous (AV) access were estimated with Fine and Gray models. RESULTS Living-donor candidates used pretransplant peritoneal dialysis at rates similar to deceased-donor KT candidates, but had significantly more frequent catheter than AV access for hemodialysis (adjusted OR 1.25; 95%CI 1.09-1.43). Over a median follow-up of 43 (IQR: 23-67) months, 6063 patients received transplants and 305 died before KT. Median duration of pretransplant dialysis was 15 (7-27) months for deceased-donor recipients and 9 (5-15) for living-donor recipients. Catheter use in deceased-donor candidates was associated with a lower SHR for KT (0.88, 95%CI 0.82-0.94) and a higher SHR for death (1.53, 95%CI 1.14-2.04). Only five deaths occurred in living-donor candidates, three of them with catheter use. CONCLUSIONS Pretransplant dialysis duration may be quite long even when planned with a living donor. Advantages from protecting these patients from AV fistula creation must be carefully evaluated against catheter-related risks.
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Affiliation(s)
- Raphaëlle Sylvestre
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Vascular Surgery, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Natalia Alencar de Pinho
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.
| | - Ziad A Massy
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Christian Jacquelinet
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Agence de la Biomédecine, Direction Médicale et Scientifique, Boulogne-Billancourt, France
| | - Mathilde Prezelin-Reydit
- Aurad-Aquitaine, Service Hémodialyse, Saint Denis La Plaine, France.,Bordeaux Population Health Research Center, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, University of Bordeaux, INSERM, UMR1219, Bordeaux, France
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France
| | - Raphael Coscas
- Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France.,Division of Vascular Surgery, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
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Lok CE, Moist L. KDOQI 2019 Vascular Access Guidelines: What Is New? Adv Chronic Kidney Dis 2020; 27:171-176. [PMID: 32891299 DOI: 10.1053/j.ackd.2020.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/01/2020] [Accepted: 02/17/2020] [Indexed: 11/11/2022]
Abstract
The new Kidney Disease Outcomes Quality Initiative Vascular Access Guidelines now focus on a more comprehensive overall patient strategy. The patient's vascular access needs are part of a dialysis access strategy, which itself is part of an End Stage Kidney Disease Life-Plan strategy that stems from a unique patient's individualized needs. The End Stage Kidney Disease Life-Plan is an individualized and comprehensive map for dialysis modalities and dialysis access for the lifetime of the patient. New targets are introduced that align with this patient-centered approach. The Guidelines made significant changes to the use of surveillance techniques to detect stenosis and found insufficient evidence to make a recommendation for routine arteriovenous fistula surveillance by measuring access blood flow, pressure monitoring, or imaging for stenosis that was in addition to routine clinical monitoring. Routine surveillance is not recommended in arteriovenous grafts. Similarly, pre-emptive angioplasty of arteriovenous fistulas or arteriovenous grafts with stenosis, not associated with clinical indicators, is not recommended. The Guidelines represent a rigorous review of the evidence; however, the available evidence to guide vascular access practice remains limited. There is a significant need and opportunity for new and ongoing high-quality research to inform best practice.
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Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 865] [Impact Index Per Article: 216.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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Abstract
INTRODUCTION Patients with advanced kidney disease (AKD) have to make difficult treatment modality decisions as their disease progresses towards end-stage kidney disease. International guidelines in nephrology suggest shared decision-making (SDM) to help patients make timely treatment modality decisions that align with their values and preferences. However, systematic reviews or scoping reviews on these SDM interventions and on their reported use or outcomes are lacking. This limits the adoption of SDM in clinical practice and hampers further research and development on the subject. Our aim is to provide a comprehensive and up-to-date overview of these SDM interventions by means of a scoping review of the literature. Scoping reviews can provide a broad overview of a topic, identify gaps in the research knowledge base and report on the types of evidence that address and inform practices. This paper presents our study protocol. METHODS AND ANALYSIS The proposed scoping review will be performed in accordance with the Joanna Briggs Institute's (JBI) methodology for scoping reviews. It will cover both qualitative and quantitative scientific literature, as well as the grey literature on SDM interventions for treatment modality decisions in AKD. Only literature written in English will be considered for inclusion. Two independent reviewers will participate in an iterative process of screening the literature, paper selection and data extraction. Disagreements between the reviewers will be resolved by discussion until consensus is reached or after consultation with the research team when needed. Results will be reported with descriptive statistics and diagrammatic or tabular displayed information, accompanied by narrative summaries as explained in the JBI guidelines. ETHICS AND DISSEMINATION Ethical approval for the conduct of this study is not required. We will analyse previously collected data for the proposed scoping review. Our results will be published in a peer-reviewed journal and disseminated through conferences and/or seminars.
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Affiliation(s)
- Noel Engels
- Shared decision making, Santeon, Utrecht, Utrecht, The Netherlands
| | - Gretchen de Graav
- Internal Medicine, Maasstad Ziekenhuis, Rotterdam, Zuid-Holland, The Netherlands
| | | | | | - Willem Jan Bos
- Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Leiden University Medical Center, Leiden, Zuid Holland, The Netherlands
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Nordyke RJ, Nicholson G, Gage SM, Lithgow T, Himmelfarb J, Rivara MB, Hays RD, Woo K, Peipert JD. Vascular access-specific health-related quality of life impacts among hemodialysis patients: qualitative development of the hemodialysis access-related quality of life (HARQ) instrument. BMC Nephrol 2020; 21:16. [PMID: 31937249 PMCID: PMC6958666 DOI: 10.1186/s12882-020-1683-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/03/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND End stage kidney disease and hemodialysis dependence are associated with impairments in health-related quality of life (HRQOL), which may be related to vascular access (VA). Few HRQOL measures are VA-specific and none differentiate HRQOL impact by VA type. We developed a VA-targeted HRQOL measure to distinguish the impact of fistulas, grafts and catheters. METHODS We created an initial item pool based on literature review and then conducted focus groups at 4 US sites with 37 adults and interviews with nine dialysis clinicians about VA's impact on HRQOL. We then drafted the Hemodialysis Access-Related Quality of Life (HARQ) measure and cognitively tested it with 17 hemodialysis patients. Focus group and cognitive interview participants were diverse in age, gender, years on dialysis, and VA. RESULTS We identified six domains for the HARQ: symptoms, physical functioning, emotional impacts, social and role functioning, sleep, and care-related burdens. Cognitive interviews indicated that items were easily understood and supported content validity. Attributing HRQOL impact to VA as opposed to other hemodialysis burden was challenging for some items. Some items were dropped that were considered redundant by patients, limitations while dressing was added, and reference to VA-specific impact was included for each item. The average Flesch-Kincaid reading grade level for the revised 47-item HARQ was 5.3. CONCLUSIONS The HARQ features VA-specific content not addressed in other HRQOL measures, making it ideal for comparisons of different VA types and new VA technologies. The psychometric properties of the HARQ will be evaluated in future research.
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Affiliation(s)
| | | | | | | | - Jonathan Himmelfarb
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ron D Hays
- Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Karen Woo
- Department of Surgery, UCLA, Los Angeles, CA, USA
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kong X, Tang L, Liang L, Cao W, Zhang L, Yong W, Ding N, Li W, Wang Z, Xu D. Clinical outcomes following the surgery of new autologous arteriovenous fistulas proximal to the failed ones in end-stage renal disease patients: a retrospective cohort study. Ren Fail 2019; 41:1036-1044. [PMID: 31814501 PMCID: PMC6913653 DOI: 10.1080/0886022x.2019.1696210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Most prior studies have explored surgery for the treatment of failed autologous arteriovenous fistulas (AVFs) with limited follow-up times and a lack of end point mortality. Accordingly, we conducted a retrospective cohort study to evaluate the clinical outcomes of the surgery of new AVF proximal to the failed forearm AVF. Methods: In this study, 538 end-stage renal disease patients (group A, 418 with primary AVF; and group B, 120 with failed AVF) were consecutively enrolled between January 2013 and June 2016, with a median follow-up time of 41 months. Primary and secondary patency, all-cause mortality, and risk factors associated with AVF failure were explored by the Kaplan–Meier method or Cox proportional hazards model. Results: In group A (n = 418), the primary and secondary patencies of AVF were 85.6% vs. 96.8%, 79.7% vs. 95.0%, 75.1% vs.93.9%, 73.2% vs. 93.6% and 73.2% vs. 93.6% at 12, 24, 36, 48 and 60 months, respectively. The primary patencies of AVF in group B were 95.0%, 91.7%, 89.2%, 88.3% and 88.3% at 12, 24, 36, 48 and 60 months, respectively. After adjusting for potential confounders, age, angiotensin-converting inhibitors or angiotensin-receptor blockers (anti-RAAS) drugs and D-dimer were independent predictors of AVF failure. However, there were no differences between functional and failed AVF regarding all-cause mortality. Conclusions: The study revealed that the primary and secondary patiencies of the surgery of new AVF proximal to the failed ones were ideal operations to restore failed forearm AVF.
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Affiliation(s)
- Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Cao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Lei Zhang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Yong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Nannan Ding
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wenbin Li
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zunsong Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China.,Nephrology Research Institute of Shandong Province, Jinan, China
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40
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Nair D, Wilson FP. Patient-Reported Outcome Measures for Adults With Kidney Disease: Current Measures, Ongoing Initiatives, and Future Opportunities for Incorporation Into Patient-Centered Kidney Care. Am J Kidney Dis 2019; 74:791-802. [PMID: 31492487 PMCID: PMC6875620 DOI: 10.1053/j.ajkd.2019.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/11/2019] [Indexed: 01/21/2023]
Abstract
Tools that measure patients' experiences and perceptions of disease are increasingly being recognized as important components of a multidisciplinary personalized approach to care. These patient-reported outcome measures (PROMs) have the ability to provide clinicians, researchers, and policymakers with valuable insights into patients' symptoms and experiences that are unable to be ascertained by laboratory markers alone. If developed rigorously, studied systematically, and used judiciously, PROMs can effectively incorporate the patient voice into clinical care, clinical trials, and health care policy. PROMs have continued to gain attention and interest within the nephrology community, but key challenges and opportunities for their seamless uptake and integration remain. In this narrative overview, we provide nephrologists with a comprehensive list of existing PROMs developed for adults with kidney disease with information on their gaps and limitations; a rationale to support the continued incorporation of PROMs into nephrology clinical trials, clinical care, and health care policy; and a summary of ongoing initiatives and future opportunities to do so.
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Affiliation(s)
- Devika Nair
- Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Center for Kidney Disease, Nashville, TN
| | - F Perry Wilson
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT.
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Affiliation(s)
- Charmaine E Lok
- Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital and The University of Toronto, Toronto, Ontario, Canada
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42
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Auguste BL, Chan CT. Home Dialysis Among Elderly Patients: Outcomes and Future Directions. Can J Kidney Health Dis 2019; 6:2054358119871031. [PMID: 31523436 PMCID: PMC6732853 DOI: 10.1177/2054358119871031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/16/2019] [Indexed: 12/18/2022] Open
Abstract
Elderly patients who receive home dialysis (peritoneal dialysis or home hemodialysis) may have reduced survival compared to younger patients. Therefore, it is important to ascertain the goals of home dialysis in the elderly rather than simply fixate on standard metrics such as technique survival. As Canada's population continues to age, the prevalence of end-stage kidney disease among the elderly population is increasing. Patients with multiple comorbidities are now surviving long enough to be started on dialysis. Although home dialysis has been associated with better survival and improved quality of life, its impact on the frail and elderly populations require further elucidation. Home dialysis patients can either independently perform tasks or have support in the home to safely conduct dialysis. Moreover, patients burdened with frailty and multiple comorbidities who lack support in the home may not be able to perform home dialysis safely. Innovative strategies to improve accessibility to home-based therapies need further exploration. In addition, the concept of goal-directed dialysis promotes more individualized treatment. Future continuous quality improvement initiatives must examine if goal-directed dialysis leads to better quality of life outcomes in the elderly.
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Abstract
Choosing the optimal hemodialysis vascular access for the elderly patient is best achieved by a patient-centered coordinated multidisciplinary team approach that aligns the patient's end-stage kidney disease Life-Plan, i.e., the individual treatment approach (supportive care, time-limited or long-term kidney replacement therapy, or combination thereof) and selection of dialysis modality (peritoneal dialysis versus hemodialysis) with the most suitable dialysis access. Finding the right balance between the patient's preferences, the likelihood of access function and survival, and potential complications in the context of available resources and limited patient survival can be extremely challenging. The framework for choosing the most appropriate vascular access for the elderly presented in this review considers the individual end-stage kidney disease Life-Plan, the patient life expectancy, the likelihood of access function and survival, the timing of dialysis relative to access placement, prior access history, and patient preference. This complex decision-making process should be dynamic in order to accommodate patients' changing needs and life and health circumstances. Effective and timely communication between the patient, their caregivers, and treating team is key to delivering truly patient-centered care. Delivering this care also requires overcoming the limitations of the currently available evidence that is predominantly based on observational data with its inherent risks of bias. While challenging, future randomized controlled studies exploring the risks, benefits, costs, and timing of placement of available access types in the elderly are required to help us "get it right" for our patients.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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45
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Viecelli AK, Howell M, Tong A, Teixeira-Pinto A, O’Lone E, Ju A, Craig JC, Hooi LS, Lee T, Lok CE, Polkinghorne KR, Quinn RR, Vachharajani TJ, Vanholder R, Zuo L, Tordoir J, Pecoits-Filho R, Yuo T, Kopperschmidt P, Smith R, Irish AB, Mori TA, Pascoe EM, Johnson DW, Hawley CM. Identifying critically important vascular access outcomes for trials in haemodialysis: an international survey with patients, caregivers and health professionals. Nephrol Dial Transplant 2019; 35:657-668. [DOI: 10.1093/ndt/gfz148] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes.
Method
Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7–9 being critically important). The relative importance was determined by a best–worst scale using multinomial logistic regression. Open text responses were analysed thematically.
Results
The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best–worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best–worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle.
Conclusions
Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
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Affiliation(s)
- 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
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | | | - Emma O’Lone
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Lai-Seong Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Timmy Lee
- Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Nephrology, Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, VC, Australia
- Department of Medicine, Monash University, Melbourne, VC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VC, Australia
| | - Robert R Quinn
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Tushar J Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Jan Tordoir
- Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Theodore Yuo
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Rob Smith
- Nightcliff Renal Unit, Darwin, NT, Australia
| | - Ashley B Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Carmel M 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
- Translational Research Institute, Brisbane, QLD, Australia
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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34:ii1-ii42. [PMID: 31192372 DOI: 10.1093/ndt/gfz072] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | | | | | - Jan Tordoir
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Davide Bolignano
- Institute of Clinical Physiology of the Italian National Council of Research, Reggio Calabria, Italy.,ERBP, guideline development body of ERA-EDTA, London, UK
| | | | | | | | - Christiane Drechsler
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Würzburg, Würzburg, Germany
| | - Tevfik Ecder
- Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | | | - Maria Haller
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | - Sam Heye
- Jessa Hospital, Hasselt, Belgium
| | - Jose Ibeas
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Aurangzaib Khawaja
- Queen Elisabeth Hospital, University Hospitals Birmingham, West Midlands Deanery, Birmingham, UK
| | | | - Carlo Lomonte
- Miulli General Hospital, Acquaviva delle Fonti, Italy
| | | | | | | | | | | | | | - Ionut Nistor
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Medicine and Pharmacy, Iasi, Romania
| | - Nils Planken
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ramon Roca-Tey
- Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain
| | - Rose Ross
- Ninewells Hospital Scotland, Dundee, UK
| | | | | | | | | | | | - Teun Wilmink
- Heart of England NHS foundation Trust, Birmingham, UK
| | - Muguet Koobasi
- ERBP, guideline development body of ERA-EDTA, London, UK
| | - Jonathan Fox
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Glasgow, UK
| | - Wim Van Biesen
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
| | - Evi Nagler
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
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Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney Int 2019; 95:1053-1063. [DOI: 10.1016/j.kint.2018.11.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
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Viecelli AK, Polkinghorne KR, Pascoe EM, Paul-Brent PA, Hawley CM, Badve SV, Cass A, Hooi LS, Kerr PG, Mori TA, Ong LM, Voss D, Johnson DW, Irish AB; Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group. Fish oil and aspirin effects on arteriovenous fistula function: Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial. PLoS One 2019; 14:e0213274. [PMID: 30913208 DOI: 10.1371/journal.pone.0213274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/18/2019] [Indexed: 01/25/2023] Open
Abstract
Background Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements. Methods In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation. Results Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64% male, 45% diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54–0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95% CI 0.34–0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27–0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation. Conclusion Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.
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Moist L, Lok CE. Con: Vascular access surveillance in mature fistulas: is it worthwhile? Nephrol Dial Transplant 2019; 34:1106-1111. [DOI: 10.1093/ndt/gfz004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
The risks and benefits of hemodialysis arteriovenous (AV) access surveillance have been debated since the introduction of AV access surveillance techniques. The debate is fuelled by the lack of robust, high-quality evidence with consistent and comparable patient-important outcomes. Additionally, there is a lack of clarity regarding the diagnostic cut points for AV access stenosis using the various surveillance techniques, questions about the appropriateness of the ‘knee-jerk’ response to intervention on a stenosis >50% regardless of the presence of clinical indicators and whether the intervention results in desired patient-important outcomes. The physiology of the AV access is complex considering the different hemodynamics within an AV fistula, which vary by time of dialysis, location, size of vessels and location of the stenosis. The current evidence suggests that the use of AV access surveillance in an AV fistula does detect more stenosis compared with clinical monitoring alone and leads to an increased number of procedures. It remains uncertain if that leads to improved patient-important outcomes such as prolonged AV fistula patency. Vascular access is an essential component of hemodialysis and further study is needed to clarify this long-standing debate. There needs to be better distinction between the strategies of vascular access surveillance, clinical monitoring with clinical indictors and preemptive intervention and their respective impacts on patient-important outcomes. Randomized controlled studies must be conducted with defined indications for intervention, reproducible methods of intervention and clinically important AV fistula and patient outcomes. The current guidelines need to be challenged and revised to permit these necessary studies to be done.
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Affiliation(s)
- Louise Moist
- Division of Nephrology, Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
- Kidney Clinical Research Unit, London Health Sciences Center, London, ON, Canada
| | - Charmaine E Lok
- Department of Medicine, Division of Nephrology, University Health Network-Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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50
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Tong A, Manns B, Wang AYM, Hemmelgarn B, Wheeler DC, Gill J, Tugwell P, Pecoits-Filho R, Crowe S, Harris T, Van Biesen W, Winkelmayer WC, Levin A, Thompson A, Perkovic V, Ju A, Gutman T, Bernier-Jean A, Viecelli AK, O'Lone E, Shen J, Josephson MA, Cho Y, Johnson DW, Sautenet B, Tonelli M, Craig JC; SONG Implementation Workshop Investigators. Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop. Kidney Int 2018; 94:1053-68. [PMID: 30360959 DOI: 10.1016/j.kint.2018.08.018] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 02/08/2023]
Abstract
There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes.
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