Publications
301 results found
Davies SJ, Brown EA, Reigel W, et al., 2020, What is the link between poor ultrafiltration and increased mortality in anuric patients on automated peritoneal dialysis? Analysis of data from EAPOS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 26, Pages: 458-465, ISSN: 0896-8608
- Author Web Link
- Cite
- Citations: 30
Brown EA, Bargman J, van Biesen W, et al., 2020, LENGTH OF TIME ON PERITONEAL DIALYSIS AND ENCAPSULATING PERITONEAL SCLEROSIS - POSITION PAPER FOR ISPD: 2017 UPDATE, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 362-374, ISSN: 0896-8608
- Author Web Link
- Cite
- Citations: 79
Metraiah EH, Brown EA, 2019, Comprehensive conservative care for patients with advanced chronic kidney disease, Medicine (United Kingdom), Vol: 47, Pages: 614-617, ISSN: 1357-3039
The number of patients given renal replacement therapy (RRT) has expanded significantly over the last few decades, but it is increasingly recognized that such invasive treatment might not offer the intended and desired quality of life for very frail, elderly people and those with multiple co-morbidities. Comprehensive conservative care is an increasingly accepted and recognized way to provide viable, high-quality treatment for patients with advanced chronic kidney disease (CKD) who are unlikely to benefit from or choose not to have RRT. Comprehensive conservative care comprises interventions to delay progression of CKD and mitigate associated risks and complications, active managements of symptoms, shared decision-making, advance care-planning and psychosocial and family support. Use of symptom assessment tools is encouraged in clinical practice as a way to measure symptom burden and focus efforts on what matters to patients and their caregivers.
Crabtree JH, Shrestha BM, Chow K-M, et al., 2019, Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update, Peritoneal Dialysis International, Vol: 39, Pages: 414-436, ISSN: 0896-8608
The success of peritoneal dialysis (PD) as renal replacement therapy depends upon a safe, functional, and durable catheter access to the peritoneal cavity provided in a timely fashion. Catheter complications often lead to catheter loss and contribute to technique failure. With improvements in prevention and treatment of peritonitis, the impact of catheter-related infections and mechanical problems on PD technique survival has become more apparent.Guideline committees under the sponsorship of the International Society for Peritoneal Dialysis (ISPD) periodically update best practices for optimal peritoneal access (1–4). Recent advances in our understanding of the key aspects of providing successful placement and maintenance of peritoneal catheters compels the current update. Assessment of evidence for guidelines recommendations is made using a modification of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system for classification of the level of evidence and grade of recommendations (5). Where scientific evidence is not available, recommendations are based on a consensus opinion. The bibliography supporting the recommendations is not intended to be comprehensive. When there are multiple similar reports on the same subject, the committee prefers to cite the more recent publications.Within each recommendation, strength is indicated as Level 1 (we recommend), Level 2 (we suggest), or not graded, and the quality of the supporting evidence is shown as A (high quality), B (moderate quality), C (low quality), or D (very low quality). The recommendations are not meant to be implemented indiscriminately in every instance but adapted as necessary according to local circumstances and the clinical situation. While many of the general principles presented here may be applied to pediatric patients, the focus of these guidelines is on adults. Clinicians who take care of pediatric PD patients should refer to the latest ISPD guidelines covering this
Manera KE, Tong A, Craig JC, et al., 2019, An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis., Kidney Int, Vol: 96, Pages: 699-710
Shared decision-making about clinical care options in end-stage kidney disease is limited by inconsistencies in the reporting of outcomes and the omission of patient-important outcomes in trials. Here we generated a consensus-based prioritized list of outcomes to be reported during trials in peritoneal dialysis (PD). In an international, online, three-round Delphi survey, patients/caregivers and health professionals rated the importance of outcomes using a 9-point Likert scale (with 7-9 indicating critical importance) and provided comments. Using a Best-Worst Scale (BWS), the relative importance of outcomes was estimated. Comments were analyzed thematically. In total, 873 participants (207 patients/caregivers and 666 health professionals) from 68 countries completed round one, 629 completed round two and 530 completed round three. The top outcomes were PD-related infection, membrane function, peritoneal dialysis failure, cardiovascular disease, death, catheter complications, and the ability to do usual activities. Compared with health professionals, patients/caregivers gave higher priority to six outcomes: blood pressure (mean difference, 0.4), fatigue (0.3), membrane function (0.3), impact on family/friends (0.1), peritoneal thickening (0.1) and usual activities (0.1). Four themes were identified that underpinned the reasons for ratings: contributing to treatment longevity, preserving quality of life, escalating morbidity, and irrelevant and futile information and treatment. Patients/caregivers and health professionals gave highest priority to clinical outcomes. In contrast to health professionals, patients/caregivers gave higher priority to lifestyle-related outcomes including the impact on family/friends and usual activities. Thus, prioritization will inform a core outcome set to improve the consistency and relevance of outcomes for trials in PD.
Arulkumaran N, Navaratnarajah A, Pillay C, et al., 2019, Causes and risk factors for acute dialysis initiation among patients with end-stage kidney disease-a large retrospective observational cohort study, CLINICAL KIDNEY JOURNAL, Vol: 12, Pages: 550-558, ISSN: 2048-8505
- Author Web Link
- Cite
- Citations: 16
Brown EA, Farrington K, 2019, Geriatric Assessment in Advanced Kidney Disease., Clin J Am Soc Nephrol, Vol: 14, Pages: 1091-1093
Beckwith H, Clemenger M, McGrory J, et al., 2019, Repeat peritoneal dialysis exit-site infection: definition and outcomes, Peritoneal Dialysis International, Vol: 39, Pages: 344-349, ISSN: 0896-8608
Background: The most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.Methods: Retrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.Results: Overall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus (n = 16, 52%) and Pseudomonas aeruginosa (n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).Conclusion: We have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.
Chan CT, Blankestijn PJ, Dember LM, et al., 2019, Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, KIDNEY INTERNATIONAL, Vol: 96, Pages: 37-47, ISSN: 0085-2538
- Author Web Link
- Cite
- Citations: 170
Harris DCH, Davies SJ, Finkelstein FO, et al., 2019, Increasing access to integrated ESKD care as part of universal health coverage, Kidney International, Vol: 95, Pages: S1-S33, ISSN: 0085-2538
The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious hea
Iyasere O, Brown EA, Johansson L, et al., 2019, Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis, Clinical Kidney Journal, Vol: 12, Pages: 262-268, ISSN: 2048-8505
BackgroundThere is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.73 m2 (i.e. individuals with ESKD otherwise likely to be managed with dialysis).MethodsCKM patients were propensity matched to HD and aPD patients by age, gender, ethnicity, diabetes status and index of deprivation. QoL outcomes measured were Short Form-12 (SF12), Hospital Anxiety and Depression Scale depression score, symptom score, Illness Intrusiveness Rating Scale (IIRS) and Renal Treatment Satisfaction Questionnaire. Frailty was assessed using the Clinical Frailty Scale. Generalized linear modelling was used to assess the impact of treatment modality on QoL outcomes, adjusting for baseline characteristics.ResultsIn total, 84 (28 CKM, 28 HD and 28 PD) patients were included. Median age for the cohort was 82 (79–88) years. Compared with CKM, aPD was associated with higher SF12 physical component score (PCS) [Exp B (95% confidence interval) = 1.20 (1.00–1.45), P < 0.05] and lower symptom score [Exp B = 0.62 (0.43–0.90), P = 0.01]; depression score was lower in HD compared with CKM [Exp B = 0.70 (0.52–0.92), P = 0.01]. Worsening frailty was associated with higher depression scores [Exp B = 2.59 (1.45–4.62), P < 0.01], IIRS [Exp B = 1.20 (1.12–1.28), P < 0.01] and lower SF12 PCS [Exp B = 0.87 (0.83–0.93), P < 0.01].ConclusionTr
Ghanem A, Palmer A, Brown E, et al., 2019, Sleeve gastrectomy in a patient with Continuous Ambulatory Peritoneal Dialysis, 10th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: SPRINGER, Pages: S15-S15, ISSN: 0960-8923
Iyasere O, Brown E, Gordon F, et al., 2019, LONGITUDINAL TRENDS IN QUALITY OF LIFE AND PHYSICAL FUNCTION IN FRAIL OLDER DIALYSIS PATIENTS: A COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND IN-CENTER HEMODIALYSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 39, Pages: 112-118, ISSN: 0896-8608
- Author Web Link
- Cite
- Citations: 26
Brown EA, 2019, Influence of Reimbursement Policies on Dialysis Modality Distribution around the World., Clin J Am Soc Nephrol, Vol: 14, Pages: 10-12
Manera KE, Johnson DW, Craig JC, et al., 2019, Patient and Caregiver Priorities for Outcomes in Peritoneal Dialysis Multinational Nominal Group Technique Study, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: AMER SOC NEPHROLOGY, Pages: 74-83, ISSN: 1555-9041
- Author Web Link
- Cite
- Citations: 78
van Loon IN, Joosten H, Iyasere O, et al., 2019, The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study., Arch Gerontol Geriatr, Vol: 83, Pages: 285-291
BACKGROUND: As the numbers of older patients on dialysis rise, geriatric problems such as falling become more prevalent. We aimed to assess the prevalence of falls and the impact on mortality and quality of life in frail elderly patients on assisted PD (aPD) and hemodialysis (HD) from the FEPOD Study. METHODS: Data on falls and quality of life were collected with questionnaires at baseline and every six months during 2-year follow-up. Multiple regression analysis was used to evaluate factors associated with falls. Additionally, we performed a review of literature concerning the relation between falls and poor outcome. RESULTS: Baseline fall data were available for 203 patients and follow-up data for 114 patients. Dialysis modality was equally distributed (49% HD and 51% aPD). Mean (SD) age was 75 ± 7 years. Fall rate was 1.00 falls/patient year, comparable in HD and aPD. Falls led to fear of falling, resulting in less activities in 68% vs 42% (p < 0.01) and leaving the house less in 59% vs 31% (p < 0.01) of patients. Patients with diabetes mellitus were twice as likely to report falls at baseline (OR 1.91 [95%CI 1.00-3.63], p = 0.05) and falls at baseline were associated with falls during follow-up (OR 2.53 [95%CI 1.06-6.04] p = 0.03). Literature revealed frailty was a strong risk factor for falling and falling results in a higher mortality and hospitalization rate. CONCLUSION: Falls were frequent in older dialysis patients and have a negative impact on quality of life. Fall incidence is comparable between aPD and HD.
Tong A, Manns B, Wang AYM, et al., 2018, Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop, Kidney International, Vol: 94, Pages: 1053-1068, ISSN: 0085-2538
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.
Corbett RW, Brown E, 2018, Conventional Dialysis in The Elderly: How Lenient Should Our Guidelines Be?, Seminars in Dialysis, ISSN: 0894-0959
Pillay C, Arulkumaran N, Navaratnarajah A, et al., 2018, FACTORS CONTRIBUTING TO ACUTE RENAL REPLACEMENT THERAPY INITIATION IN PATIENTS WITH END-STAGE RENAL DISEASE - OUTCOMES FROM A LARGE RETROSPECTIVE COHORT STUDY, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: OXFORD UNIV PRESS, Pages: 563-564, ISSN: 0931-0509
Abdulla A, Wright PN, Ross LE, et al., 2017, Proceedings From the Symposium on Kidney Disease in Older People: Royal Society of Medicine, London, January 19, 2017, GERONTOLOGY AND GERIATRIC MEDICINE, Vol: 3
- Author Web Link
- Cite
- Citations: 6
Vanholder R, Annemans L, Brown E, et al., 2017, Further approaches to reduce the cost of renal replacement therapy, NATURE REVIEWS NEPHROLOGY, Vol: 13, ISSN: 1759-5061
- Author Web Link
- Cite
- Citations: 1
Manera KE, Tong A, Craig JC, et al., 2017, STANDARDIZED OUTCOMES IN NEPHROLOGY-PERITONEAL DIALYSIS (SONG-PD): STUDY PROTOCOL FOR ESTABLISHING A CORE OUTCOME SET IN PD, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 639-647, ISSN: 0896-8608
- Author Web Link
- Cite
- Citations: 34
Van Biesen W, Brown EA, 2017, Diagnostic and therapeutic approach to peritonitis, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 32, Pages: 1283-1284, ISSN: 0931-0509
- Author Web Link
- Cite
- Citations: 2
Vanholder R, Annemans L, Brown E, et al., 2017, Reducing the costs of chronic kidney disease while delivering quality health care: a call to action, NATURE REVIEWS NEPHROLOGY, Vol: 13, Pages: 393-409, ISSN: 1759-5061
- Author Web Link
- Cite
- Citations: 168
Wilkinson E, Randhawa G, Brown E, et al., 2017, Time, timing, talking and training: Findings from an exploratory action research study to improve quality of end of life care for minority ethnic kidney patients, Clinical Kidney Journal, Vol: 10, Pages: 419-424, ISSN: 2048-8505
Background. With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. Aim. This study purposively explored South Asian patients' experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Methods. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women). Emergent themes from the focus groups were analysed thematically. The research took place at four UK centres providing kidney care to diverse populations: West London, Luton, Leicester and Bradford. Results. Key themes related to time and the timing of discussions about end of life care and the factors that place limitations on patients and providers in talking about end of life care. Lack of time and confidence of nurses in areas of kidney care, individual attitudes and workforce composition influence whether and how patients have access to end of life care through kidney services. Conclusion. Training, teamwork and time to discuss overarching issues (including timing and communication about end of life) with colleagues could support service providers to facilitate access and delivery of end of life care to this group of patients.
Di Cocco P, Papalois VE, Brown EA, et al., 2017, Management of hernias in the context of peritoneal dialysis, Surgical Aspects of Peritoneal Dialysis, Pages: 159-166, ISBN: 9783319528205
- Cite
- Citations: 1
Di Cocco P, Brown EA, Papalois VE, et al., 2017, Overview of catheter choices and implantation techniques, Surgical Aspects of Peritoneal Dialysis, Pages: 47-69, ISBN: 9783319528205
- Cite
- Citations: 1
Iyasere O, Brown EA, 2017, Cognitive function before and after dialysis initiation in adults with chronic kidney disease-a new perspective on an old problem?, Kidney Int, Vol: 91, Pages: 784-786
The impact of dialysis on cognitive trends is uncertain. Kurella Tamura et al. evaluated cognitive trajectories in 212 participants from the Chronic Renal Insufficiency Cohort study and found that dialysis initiation was associated with a decline in executive function. This is consistent with a cerebrovascular basis for cognitive impairment in patients with renal disease. However, larger corroborative studies are needed while targets for intervention are identified to ameliorate dialytic effects on cognitive function.
Szeto C-C, Li PK-T, Johnson DW, et al., 2017, ISPD CATHETER-RELATED INFECTION RECOMMENDATIONS: 2017 UPDATE, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 141-154, ISSN: 0896-8608
- Author Web Link
- Cite
- Citations: 181
Brown EA, Finkelstein FO, Iyasere OU, et al., 2017, Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?, KIDNEY INTERNATIONAL, Vol: 91, Pages: 294-303, ISSN: 0085-2538
- Author Web Link
- Cite
- Citations: 40
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.