Publications
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Pippias M, Alfano G, Kelly DM, et al., 2024, Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)., Kidney Int Suppl (2011), Vol: 13, Pages: 136-151, ISSN: 2157-1724
Western Europe boasts advanced health care systems, robust kidney care guidelines, and a well-established health care workforce. Despite this, significant disparities in kidney replacement therapy incidence, prevalence, and transplant access exist. This paper presents the third International Society of Nephrology Global Kidney Health Atlas's findings on kidney care availability, accessibility, affordability, and quality in 22 Western European countries, representing 99% of the region's population. The known chronic kidney disease (CKD) prevalence across Western Europe averages 10.6%, slightly above the global median. Cardiovascular diseases account for a substantial portion of CKD-related deaths. Kidney failure incidence varies. Government health expenditure differs; however, most countries offer government-funded acute kidney injury, dialysis, and kidney transplantation care. Hemodialysis and peritoneal dialysis are universally available, with variations in the number of dialysis centers. Kidney transplantation is available in all countries (except for 3 microstates), with variable transplant center prevalence. Conservative kidney management (CKM) is increasingly accessible. The region's kidney care workforce is substantial, exceeding global averages; however, workforce shortages are reported. Barriers to optimal kidney care include limited workforce capacity, lack of surveillance mechanisms, and suboptimal integration into national noncommunicable disease (NCD) strategies. Policy recognition of CKD as a health priority varies across countries. Although Western Europe exhibits strong kidney care infrastructure, opportunities for improvement exist, particularly in CKD prevention, surveillance, awareness, and policy implementation. Efforts to improve CKD care should include automated detection, educational support, and enhanced workflows. Based on these findings, health care professionals, stakeholders, and policymakers are called to act to enhance kidney care across
Malho Guedes A, Punzalan S, Brown EA, et al., 2023, Assisted PD throughout Europe: advantages, inequities, and solution proposals., J Nephrol, Vol: 36, Pages: 2549-2557
BACKGROUND: Peritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mastered this, while others are still bound by the availability of a volunteer to become responsible for treatment. METHODS: A group of leading nephrologists from 13 European countries integrated real-life application of such therapy, highlighting barriers, lessons learned and practical solutions. The objective of this work is to share and summarize several different approaches, with their intrinsic difficulties and solutions, which might helpperitoneal dialysis units to develop and offer assisted peritoneal dialysis. RESULTS: Assisted peritoneal dialysis does not mean 4 continuous ambulatory peritoneal dialysis exchanges, 7 days/week, nor does it exclude cycler. Many different prescriptions might work for our patients. Tailoring PD prescription to residual kidney function, thereby maintaining small solute clearance, reduces dialysis burden and is associated with higher technique survival. Assisted peritoneal dialysis does not mean assistance will be needed permanently, it can be a transitional stage towards individual or caregiver autonomy. Private care agencies can be used to provide assistance; other options may involve implementing PD training programs for the staff of nursing homes or convalescence units. Social partners may be interested in participating in smaller initiatives or for limited time periods. CONCLUSION: Assisted peritoneal dialysis is a valid technique, which should be expanded. In countries without structural models of assisted peritoneal dialysis, active involvement by the nephrologist is needed in order for it to become a reality.
Ng MSN, Brown EA, Cheung M, et al., 2023, The role of nephrology nurses in symptom management – reflections on the kidney disease: improving global outcomes controversies conference on symptom-based complications in dialysis care, Kidney International Reports, Vol: 8, Pages: 1903-1906, ISSN: 2468-0249
Dhoot A, Brown EA, Robinson B, et al., 2023, Incremental peritoneal dialysis: Incremental gains, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 43, Pages: 355-358, ISSN: 0896-8608
Mehrotra R, Davison SN, Farrington K, et al., 2023, Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, KIDNEY INTERNATIONAL, Vol: 104, Pages: 441-454, ISSN: 0085-2538
Corbett RW, Beckwith H, Lucisano G, et al., 2023, Delivering Person-Centered Peritoneal Dialysis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, ISSN: 1555-9041
Vanholder R, Annemans L, Braks M, et al., 2023, Inequities in kidney health and kidney care, NATURE REVIEWS NEPHROLOGY, ISSN: 1759-5061
Beckwith H, Thind A, Brown EA, 2023, Perceived life expectancy among dialysis recipients: a scoping review, Kidney Medicine, Vol: 5, Pages: 1-9, ISSN: 2590-0595
Rationale & Objective:Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live.Study Design:Scoping ReviewSetting and Study Population:People with kidney failure over 18 years old.Search Strategy & Sources:Studies were identified by searching Medline, Embase, APA PsycINFO, HMIC and ProQuest Database for terms related to “life expectancy”, “self -estimated” and “end stage kidney disease”.Data Extraction:Search strategies yielded 349 unique, potentially eligible studies, with 8 meeting the inclusion criteria after screening.Results:Significant mismatches between dialysis recipients and their healthcare provider estimations of prognosis were reported, with patients predicting significantly higher life expectancies than healthcare professionals and almost no agreement between patient and nephrologist estimates of one-year survival. Documented cognitive impairment did not affect 1- or 5-year prognosis estimates, neither did gender, age, time on dialysis or discussing perceived life expectancy. Dialysis recipients who thought they were on the transplant-list or self-identified as black had higher perceived life expectancy: people who were 75 years or older, or with fair/ poor self-reported health status had lower. Those with lower perceived life expectancy preferred care focusing on relieving pain and discomfort: people who thought they had a higher chance of survival were significantly more likely to prefer life-extending care.Limitations:There is a marked paucity of research in this area with most studies conducted in North American cohorts.Conclusions:Optimistic patient prognostic expectations persist in dialysis recipients. Given the effects of perceived life expectancy on treatment choices and subsequent quality of life, it is important that transparent discussions regarding prognosis are conducted with pe
Brown EA, Jha V, Abdou N, et al., 2023, Introducing the international home dialysis consortium, Kidney International Reports, Vol: 8, Pages: 1277-1280, ISSN: 2468-0249
The use of home dialysis, peritoneal dialysis (PD) and home hemodialysis (HHD), remains low despite the well-known benefits to the person on dialysis in terms of lifestyle and treatment satisfaction, and to the health care system because of lower financial costs and lesser dependence on trained professionals.1 With projections of doubling of the population of people receiving dialysis from 2010 to 2030,2 health care systems delivering dialysis therapy have the responsibility to ensure cost-effectiveness. Resources are limited, including qualified staff and finances to cover treatment costs. Remote patient monitoring holds promise of high quality follow up and improved clinical outcomes for home dialysis patients.3 Furthermore, shared decision making enables patients to choose and therefore benefit from the dialysis modality most suitable for the individual to improve their quality of life. Furthermore, by avoiding multiple journeys to a dialysis center, home dialysis is less disruptive for the environment and for those living in remote geographic areas, prevents individuals from having to relocate from their communities to urban areas for dialysis treatment. In addition, PD avoids use of large quantities of water for each treatment, which is critically important in regions with water scarcity. During the height of the COVID-19 pandemic, when even “home dialysis sceptics” perceived the advantage of dialysis at home rather than in-center, an International Home Dialysis Roundtable was convened by industry leaders to consider practical steps for increasing access to home dialysis.4 Around the same time, Kidney Disease Improving Global Outcomes held a controversies conference on home dialysis, looking at multiple facets of improving the adoption and propagation of home dialysis globally.5 Building on this work, and in the light of the global importance and interests in home dialysis, the leadership of the International Society of Nephrology and the Internatio
Beckwith H, Brown EA, 2023, Health-related quality of life in kidney transplant recipients: can we do better?, Nephrology Dialysis Transplantation, Vol: 38, Pages: 1580-1582, ISSN: 0931-0509
Chow KM, Li PK-T, Cho Y, et al., 2023, ISPD Catheter-related Infection Recommendations: 2023 Update, PERITONEAL DIALYSIS INTERNATIONAL, ISSN: 0896-8608
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Perl J, Brown EA, Chan CT, et al., 2023, Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, Publisher: ELSEVIER SCIENCE INC, Pages: 842-858, ISSN: 0085-2538
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- Citations: 5
FitzGerald TJ, Joosten H, van Buren M, et al., 2023, A review of supportive care for older people with advanced chronic kidney disease, CLINICAL KIDNEY JOURNAL, Vol: 16, Pages: 635-646, ISSN: 2048-8505
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FitzGerald TJ, Brown EA, 2023, Conservative kidney management, Medicine (United Kingdom), Vol: 51, Pages: 219-223, ISSN: 1357-3039
Conservative kidney management (CKM) is a non-dialysis treatment strategy for end-stage kidney disease (ESKD) that is associated with survival and health-related quality-of-life outcomes comparable to those of dialysis in certain older adults living with frailty and significant co-morbidity. CKM seeks to establish an individual's care goals through shared decision-making, placing a particular emphasis on quality-of-life outcomes. Early in the disease course, CKM can emphasize the medical management of advanced chronic kidney disease to limit progression, whereas later the focus can shift to managing the unpleasant symptoms of ESKD and to advance care planning. This review provides an outline of current CKM evidence and practice.
Pepereke S, Shah AD, Brown EA, 2023, Encapsulating peritoneal sclerosis: Your questions answered, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 43, Pages: 119-127, ISSN: 0896-8608
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Thind A, Brown E, Willicombe M, et al., 2023, Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study, Frontiers in Nephrology, Vol: 2, ISSN: 2813-0626
Background: Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this. We present a secondary analysis of the Edmonton Frail Scale (EFS) and its relationship with patient experience scores.Methods: The KTOP study is a single centre, prospective study, which began in October 2019. All ESKD patients aged ≥60 considered for transplantation at Imperial College Renal and Transplant Centre were eligible. Frailty was assessed using the EFS and 5 questionnaires assessed patient experience and quality of life (QoL) (Short Form-12(v2), Palliative Care Outcome Scale–Symptoms Renal, Depression Patient Health Questionnaire-9, Illness Intrusiveness Ratings Scale, Renal Treatment Satisfaction Questionnaire). The EFS was divided into 4 subdomains (psychosocial, physical function, medical status, and general health) and then compared with the questionnaire scores.Results: 210 patients have been recruited (aged 60-78), 186 of whom completed EFS assessments. 118 (63.4%) participants were not frail, 36 (19.4%) vulnerable, and 32 (17.2%) were frail. Worse frailty scores were associated with poorer patient experience and QoL scores across all questionnaires. Severe deficits in the EFS psychosocial subdomain showed a statistically significant association with higher depression screen scores (coefficient 4.9, 95% CI 3.22 to 6.59), lower physical (coefficient -4.35, 95% CI -7.59 to -1.12) and mental function scores (coefficient -8.33, 95% CI -11.77 to -4.88) from the Short Form-12(v2), and lower renal treatment satisfaction scores (coefficient -5.54, 95% CI -10.70 to -0.37). Deficits in the physical function and medical status EFS subdomians showed some association
Corbett RW, Brown EA, 2023, PD in the Older Person, Nolph and Gokal’s Textbook of Peritoneal Dialysis: Fourth Edition, Pages: 737-758, ISBN: 9783030620868
Changes in life expectancy across the globe has led to a marked demographic shift which, combined with an increasing burden of comorbidity, has led to a markedly older dialysis population. However, dialysis is only one component of the overall care of the older person with renal disease. Recognizing and assessing frailty, a process distinct from aging, is important before commencing and while on dialysis. Having assessed frailty, shared decisionmaking with the patient and family is no less important in the older person than any other patient. Shared decision-making should cover realistic care goals including quality of life, minimizing treatment burden and symptom control. While underutilized, there are many features of peritoneal dialysis which make it a suitable treatment for the older person. Individualization of the prescription should focus on preserving residual kidney function, use of low-intensity incremental regimes where possible, and assisted peritoneal dialysis where needed.
Brown EA, Ryan L, Corbett RW, 2023, A novel programme of supportive two-exchange assisted continuous ambulatory peritoneal dialysis for frail patients with end-stage kidney disease, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 43, Pages: 100-103, ISSN: 0896-8608
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- Citations: 3
Hurst H, Young HML, Nixon AC, et al., 2022, Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review., Age Ageing, Vol: 51
The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older people (≥65 years) living with frailty and ACKD. More specifically how frailty is identified, what interventions have been studied and what outcomes have been reported including outcomes important to patients, families and carers. A scoping review was undertaken following the PRISMA-Scr guidelines. Nine databases were searched and a review team of five people followed a process using defined inclusion and exclusion criteria. Data were then analysed to answer the specific questions of the review. The World Health Organization's International Classification of Functioning Disability and Health was used to map outcomes across the domains. A total of 90 studies were included. The most reported frailty measure was the frailty phenotype. The most reported outcomes were mortality, hospitalisation and healthcare utilisation. Health-related quality of life was the most common patient-reported outcome measure. There were few intervention studies and limited evidence of patient and carer perspectives. This scoping review highlights important areas for further research in older people living with frailty and ACKD. This includes a 'gold standard' measure for identifying frailty, interventions and improvements in outcome measures that matter to patients (including studies that focus on carers and carer burden) and priority setting for future research.
Jha V, Abrahams AC, Al-Hwiesh A, et al., 2022, Peritoneal catheter insertion: combating barriers through policy change, CLINICAL KIDNEY JOURNAL, Vol: 15, Pages: 2177-2185, ISSN: 2048-8505
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Beckwith H, Thomas N, Adwaney A, et al., 2022, Gender differences in experiences and expectations of haemodialysis in a frail and seriously unwell patient population, Kidney International Reports, Vol: 7, Pages: 2421-2430, ISSN: 2468-0249
IntroductionSurprisingly few studies have explored the experiences of seriously unwell people with kidney disease on haemodialysis therapy: we conducted a mixed-methods study to investigate gender differences in illness experience, symptom burden, treatment considerations or expectations in this cohort.MethodsSeriously unwell people on haemodialysis (1-year mortality risk of >20%) at three hospital-based units were invited to take part in a structured interview or to complete the same questions independently via a questionnaire. 54 people took part (36 males, 18 females); data analysis was undertaken using a thematic approach.Results‘Desire to keep living’ is the most important and basic thought process when starting dialysis. Fear also predominates influencing risk assessment and decision-making. Once fear is managed, there are physical, social, practical and emotional issues to rationalise, but choice only seems possible if shared decision-making is part of the consultation.Gender differences were seen in perceived hopes and expectations of treatment. Males were more likely to prioritise achievement of physical goals, with females prioritising a wish to feel well. Both genders reported significantly higher symptom scores than their healthcare provider perceived, however this difference was more marked in females. Dialysis regret existed in >50% of participants and 6/54 (11%) stated that they would have chosen no dialysis at all. Females were more likely to report feeling depressed (P=0.001).ConclusionDifferent genders approach treatment decisions and prioritise treatment expectations differently. Recognising this will allow personalised care plans to be developed and improve the experiences of seriously unwell people with kidney disease.
Brown EA, Ekstrand A, Gallieni M, et al., 2022, Availability of assisted peritoneal dialysis in Europe: call for increased and equal access, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 37, Pages: 2080-2089, ISSN: 0931-0509
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- Citations: 5
Sarnak MJ, Auguste BL, Brown E, et al., 2022, Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association., Circulation, Vol: 146, Pages: e146-e164
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
Thind A, Goodall D, Rule A, et al., 2022, Prevalence of frailty and cognitive impairment in older transplant candidates. A preview to the Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study, BMC Nephrology, Vol: 23, ISSN: 1471-2369
Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. Methods The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable were also eligible for enrolment into the qualitative sub-study. Results208 participants have been recruited (age 60-78). Baseline Montreal Cognitive Assessments were available for 173 participants, with 63 (36.4%) participants identified as having scores below normal (score <26). Edmonton Frail Scale assessments were available for 184 participants, with 29 participants (15.8%) identified as frail (score ³8), and a further 37 participants (20.1%) identified as being vulnerable (score 6-7). Conclusion In the KTOP study cohort we have identified a prevalence of 36.4% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 15.8% at recruitment. A further 20.1% were v
Shen JI, Cho Y, Manera KE, et al., 2022, Establishing a Core Outcome Measure for Peritoneal Dialysis-related Peritonitis: A Standardized Outcomes in Nephrology—Peritoneal Dialysis Consensus Workshop Report, Kidney International Reports, Vol: 7, Pages: 1737-1744, ISSN: 2468-0249
Introduction: Peritoneal dialysis (PD)-related peritonitis is one of the leading causes of discontinuation of PD and is considered a critically important outcome for patients on PD. However, there is no universally accepted method of measuring this outcome in clinical trials. Methods: We convened an online consensus workshop to establish a core outcome measure for PD-related peritonitis in clinical trials. Results: A total of 53 participants, including 18 patients and caregivers, from 12 countries engaged in breakout discussions in this workshop. Transcripts were analyzed thematically. We identified the following 3 themes: (i) feasibility and applicability across diverse settings, which reflected the difficulty with implementing laboratory-based measures in resource-limited environments; (ii) ensuring validity, which included minimizing false positives and considering the specificity of symptoms; and (iii) being meaningful and tangible to patients, which meant that the measure should be easy to interpret, reflect the impact that symptoms have on patients, and promote transparency by standardizing the reporting of peritonitis among dialysis units. Conclusion: A core outcome measure for PD-related peritonitis should include both symptom-based and laboratory-based criteria. Thus, the International Society for Peritoneal Dialysis (ISPD) definition of peritonitis is acceptable. However, there should be consideration of reporting suspected peritonitis in cases where laboratory confirmation is not possible. The measure should include all infections from the time of catheter insertion and capture both the rate of infection and the number of patients who remain peritonitis free. A core outcome measure with these features would increase the impact of clinical trials on the care and decision-making of patients receiving PD.
Ryan L, McNicholas J, Beckwith H, et al., 2022, 729 INCORPORATING PATIENTS' VIEWS IN THE DESIGN OF AN EDUCATIONAL LEAFLET FOR FRAIL, OLDER PATIENTS WITH KIDNEY DISEASE, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729
Fitzgerald TJ, Brown EA, 2021, What assistance does assisted peritoneal dialysis need?, Peritoneal Dialysis International, Vol: 41, Pages: 519-521, ISSN: 0896-8608
Mehrotra R, Stanaway IB, Jarvik GP, et al., 2021, A genome-wide association study suggests correlations of common genetic variants with peritoneal solute transfer rates in patients with kidney failure receiving peritoneal dialysis., Kidney Int, Vol: 100, Pages: 1101-1111
Movement of solutes across the peritoneum allows for the use of peritoneal dialysis to treat kidney failure. However, there is a large inter-individual variability in the peritoneal solute transfer rate (PSTR). Here, we tested the hypothesis that common genetic variants are associated with variability in PSTR. Of the 3561 participants from 69 centers in six countries, 2850 with complete data were included in a genome-wide association study. PSTR was defined as the four-hour dialysate/plasma creatinine ratio from the first peritoneal equilibration test after starting PD. Heritability of PSTR was estimated using genomic-restricted maximum-likelihood analysis, and the association of PSTR with a genome-wide polygenic risk score was also tested. The mean four-hour dialysate/plasma creatinine ratio in participants was 0.70. In 2212 participants of European ancestry, no signal reached genome-wide significance but 23 single nucleotide variants at four loci demonstrated suggestive associations with PSTR. Meta-analysis of ancestry-stratified regressions in 2850 participants revealed five single-nucleotide variants at four loci with suggestive correlations with PSTR. Association across ancestry strata was consistent for rs28644184 at the KDM2B locus. The estimated heritability of PSTR was 19%, and a permuted model polygenic risk score was significantly associated with PSTR. Thus, this genome-wide association study of patients receiving peritoneal dialysis bolsters evidence for a genetic contribution to inter-individual variability in PSTR.
Brown E, Zhao J, Perl J, et al., 2021, Burden of kidney disease, health-related quality of life, and employment among patients receiving peritoneal dialysis and in-center hemodialysis: findings from the DOPPS Program, American Journal of Kidney Diseases, Vol: 78, Pages: 489-500.el, ISSN: 0272-6386
Rationale & Objective:Individuals faced with decisions regarding kidney replacement therapy options need information on how dialysis treatments might affect daily activities and quality of life, and what factors might influence the evolution over time of the impact of dialysis on daily activities and quality of life.Study Design:Observational cohort study.Setting & Participants7,771 hemodialysis (HD) and peritoneal dialysis (PD) participants from 6 countries participating in the Peritoneal and Dialysis Outcomes and Practice Patterns Studies (PDOPPS/DOPPS).Predictors:Patient-reported functional status (based on daily living activities), country, demographic and clinical characteristics, and comorbidities.Outcome:Employment status and patient-reported outcomes (PROs) including Kidney Disease Quality of Life (KDQOL) instrument physical and mental component summary scores (PCS, MCS), kidney disease burden score, and depression symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score > 10).Analytical Approach:Linear regression (PCS, MCS, kidney disease burden score), logistic regression (depression symptoms), adjusted for predictors plus 12 additional comorbidities.Results:In both dialysis modalities, patients in Japan had the highest PCS and employment (55% for HD and 68% for PD), whereas those in the United States had the highest MCS score, lowest kidney disease burden, and lowest employment (20% in HD and 42% in PD). After covariate adjustment, the association of age, sex, dialysis vintage, diabetes, and functional status with PROs was similar in both modalities, with women having lower PCS and kidney disease burden scores. Lower functional status (score <11) was strongly associated with lower PCS and MCS scores, a much greater burden of kidney disease, and greater likelihood of depression symptoms (CES-D, >10). The median change in KDQOL-based PROs was negligible over 1 year in participants who completed at least 2 annual questionnai
Manera KE, Johnson DW, Cho Y, et al., 2021, Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis, Clinical Kidney Journal, Vol: 14, Pages: 1817-1825, ISSN: 2048-8505
Background. Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD). Methods. We searched the Cochrane Kidney and Transplant Specialized Register for randomized trials in PD. We extracted all reported outcome domains and measurements and analyzed their frequency and characteristics. Results. From 128 reports of 120 included trials, 80 different outcome domains were reported. Overall, 39 (49%) domains were surrogate, 23 (29%) patient-reported and 18 (22%) clinical. The five most commonly reported domains were PD-related infection [59 (49%) trials], dialysis solute clearance [51 (42%)], kidney function [45 (38%)], protein metabolism [44 (37%)] and inflammatory markers/oxidative stress [42 (35%)]. Quality of life was reported infrequently (4% of trials). Only 14 (12%) trials included a patient-reported outcome as a primary outcome. The median number of outcome measures (defined as a different measurement, aggregation and metric) was 22 (interquartile range 13-37) per trial. PD-related infection was the most frequently reported clinical outcome as well as the most frequently stated primary outcome. A total of 383 different measures for infection were used, with 66 used more than once. Conclusions. Trials in PD include important clinical outcomes such as infection, but these are measured and reported inconsistently. Patient-reported outcomes are infrequently reported and nearly half of the domains were surrogate. Standardized outcomes for PD trials are required to improve efficiency and relevance.
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