Publications
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Fitzgerald TJ, Brown EA, 2021, What assistance does assisted peritoneal dialysis need?, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 41, Pages: 519-521, ISSN: 0896-8608
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
Beckwith H, Adwaney A, Appelbe M, et al., 2021, Perceptions of illness severity, treatment goals and life expectancy: the ePISTLE study, Kidney International Reports, Vol: 6, Pages: 1558-1566, ISSN: 2468-0249
IntroductionA better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed.MethodsCase-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included.ResultsPatients predicted significantly higher life expectancies than HCPs (P < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred “care focusing on relieving pain and discomfort,” compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering.ConclusionThere is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences.
Thind A, Beckwith H, Dattani R, et al., 2021, Resuming deceased donor kidney transplantation in the COVID-19 era: what do patients want?, Transplantation Direct, Vol: 7, Pages: 1-6, ISSN: 2373-8731
Background: The rapidly evolving novel coronavirus 2019 (COVID-19) pandemic bought many kidney transplant (KT) programmes to a halt. Integral to resuming KT activity is understanding the perspectives of potential transplant candidates during this highly dynamic time. Methods: From June 1st to July 7th 2020, a telephone survey of KT candidates on the deceased donor waiting list at Imperial College Renal and Transplant Centre in West London was conducted. The survey captured ongoing COVID-19 exposure risks and patients’ views on wait list (WL) reactivation and undergoing transplantation. Results: 207 responses were received. Of the respondents 180 patients (87%) were happy to be reactivated onto the WL; with 141 patients (68%) willing to give consent to transplantation currently, whilst 53 patients (26%) felt unsure, and 13 patients (6%) would decline a KT. The vast majority of patients had no concerns. In the responses from those who were uncertain or who would decline a KT, concerns about COVID-19 infection and the need for reassurance from transplant units dominated. Universally patients wanted more information about COVID-19 infection risk with KT and the precautions being taken to reduce this risk. Conclusions: The majority of surveyed patients are in favour of reactivation and receiving a KT despite the ongoing COVID-19 pandemic. Reactivation of candidates cannot be assumed and should take an individualised approach, incorporating clinical risk with patient perspectives. Improved communication with KT candidates is highly requested.
Lunney M, Bello AK, Levin A, et al., 2021, Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 16, Pages: 79-87, ISSN: 1555-9041
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- Citations: 3
Navaratnarajah A, Clemenger M, McGrory J, et al., 2021, Flexibility in peritoneal dialysis prescription: Impact on technique survival, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 41, Pages: 49-56, ISSN: 0896-8608
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Clarke C, Lucisano G, Prendecki M, et al., 2021, Informing the risk of kidney transplantation versus remaining on the wait list in the COVID-19 era, Kidney International Reports, Vol: 6, Pages: 46-55, ISSN: 2468-0249
Introduction: There is limited data pertaining to comparative outcomes of remaining on dialysis versus kidney transplantation as the threat of COVID-19 remains. This study aims to delineate the differential risks involved using serological methods to help define exposure rates. Methods: From a cohort of 1433 patients with ESKD, we analysed COVID-19 infection rates and outcomes in 299 wait list patients compared with 237 transplant recipients within their first year post-transplant. Patients were followed over a 68-day period from the time our transplant programme closed due to COVID-19. Results: The overall mortality rate in wait list and transplant populations were equivalent, p=0.69. However, COVID-19 infection was more commonly diagnosed in the wait list patients, p=0.001, who were more likely to be tested by RT-PCR, p=0.0004. Once infection was confirmed, mortality risk was higher in the transplant patients, p=0.015. The seroprevalence in dialysis and transplant patients with undetected infection was 18.3% and 4.6% respectively, p=0.0001. After adjusting for a potential screening bias, the relative risk of death following a diagnosis of COVID-19 remained higher in transplant recipients, HR: 3.36 (1.19-9.50), p=0.022. Conclusions: In conclusion, whilst COVID-19 infection was more common in the wait list patients, a higher COVID-19 associated mortality rate was seen in transplant recipients, resulting in comparable overall mortality rates.
Harris DCH, Davies SJ, Finkelstein FO, et al., 2020, Strategic plan for integrated care of patients with kidney failure, KIDNEY INTERNATIONAL, Vol: 98, Pages: S117-S134, ISSN: 0085-2538
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- Citations: 3
Baumgart A, Manera KE, Johnson DW, et al., 2020, Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 35, Pages: 1949-1958, ISSN: 0931-0509
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- Citations: 31
Navaratnarajah A, El-Sherbini N, Brown EA, 2020, Long-term outcomes in patients with encapsulating peritoneal sclerosis managed with nutritional support, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 487-495, ISSN: 0896-8608
Brown EA, Boudville N, Finkelstein F, et al., 2020, Response to: International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis Reply, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 427-428, ISSN: 0896-8608
Ronco C, Manani SM, Giuliani A, et al., 2020, Remote patient management of peritoneal dialysis during COVID-19 pandemic, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 363-367, ISSN: 0896-8608
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- Citations: 7
Gleeson S, Navaratnarajah A, Hisole N, et al., 2020, TREATMENT OUTCOMES IN PERITONEAL DIALYSIS PERITONITIS ARE NOT AFFECTED BY DEGREE OF RESIDUAL RENAL FUNCTION, 57th ERA-EDTA Congress, Publisher: OXFORD UNIV PRESS, Pages: 1533-1533, ISSN: 0931-0509
Brown EA, Hurst H, 2020, Delivering peritoneal dialysis for the multimorbid, frail and palliative patient, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 327-332, ISSN: 0896-8608
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- Citations: 1
Blake PG, Brown EA, 2020, Person-centered peritoneal dialysis prescription and the role of shared decision-making, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 302-309, ISSN: 0896-8608
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- Citations: 6
Corbett RW, Goodlet G, MacLaren B, et al., 2020, International Society for Peritoneal Dialysis Practice Recommendations: The view of the person who is doing or who has done peritoneal dialysis, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 349-352, ISSN: 0896-8608
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- Citations: 2
Brown EA, Blake PG, Boudville N, et al., 2020, International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 40, Pages: 244-253, ISSN: 0896-8608
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- Citations: 33
Manera KE, Johnson DW, Craig JC, et al., 2020, Establishing a core outcome set for peritoneal dialysis: report of the SONG-PD (Standardized Outcomes in Nephrology-Peritoneal Dialysis) consensus workshop, American Journal of Kidney Diseases, Vol: 75, Pages: 404-412, ISSN: 0272-6386
Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology–Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities of all stakeholders. We convened an international SONG-PD stakeholder consensus workshop in May 2018 in Vancouver, Canada. Nineteen patients/caregivers and 51 health professionals attended. Participants discussed core outcome domains and implementation in trials in PD. Four themes relating to the formation of core outcome domains were identified: life participation as a main goal of PD, impact of fatigue, empowerment for preparation and planning, and separation of contributing factors from core factors. Considerations for implementation were identified: standardizing patient-reported outcomes, requiring a validated and feasible measure, simplicity of binary outcomes, responsiveness to interventions, and using positive terminology. All stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD.
Van Biesen W, Jha V, Abu-Alfa AK, et al., 2020, Considerations on equity in management of end -stage kidney disease in low- and middle -income countries, KIDNEY INTERNATIONAL SUPPLEMENTS, Vol: 10, Pages: E63-E71, ISSN: 2157-1724
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- Citations: 12
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
Brown EA, Farrington K, 2019, Geriatric Assessment in Advanced Kidney Disease., Clin J Am Soc Nephrol, Vol: 14, Pages: 1091-1093
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
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- Citations: 61
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: 1718-4304
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.
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
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
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- Citations: 10
Brown EA, 2019, Influence of Reimbursement Policies on Dialysis Modality Distribution around the World, Clinical Journal of the American Society of Nephrology, Vol: 14, Pages: 10-12, ISSN: 1555-9041
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
Manera K, Johnson D, Craig J, et al., 2018, PATIENT AND CAREGIVER PRIORITIES FOR OUTCOMES IN PERITONEAL DIALYSIS: AN INTERNATIONAL NOMINAL GROUP STUDY, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
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