Publications
235 results found
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
FitzGerald TJ, Joosten H, van Buren M, et al., 2022, A review of supportive care for older people with advanced chronic kidney disease, CLINICAL KIDNEY JOURNAL, ISSN: 2048-8505
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.
Pepereke S, Shah AD, Brown EA, 2022, Encapsulating peritoneal sclerosis: Your questions answered, PERITONEAL DIALYSIS INTERNATIONAL, ISSN: 0896-8608
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
Brown EA, Ryan L, Corbett RW, 2022, A novel programme of supportive two-exchange assisted continuous ambulatory peritoneal dialysis for frail patients with end-stage kidney disease, PERITONEAL DIALYSIS INTERNATIONAL, ISSN: 0896-8608
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- Citations: 1
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: 2
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
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: 8
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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- Citations: 7
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: 11
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: 38
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
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- Citations: 1
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: 22
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: 10
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: 11
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: 5
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: 78
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: 17
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.
Brown EA, Farrington K, 2019, Geriatric Assessment in Advanced Kidney Disease., Clin J Am Soc Nephrol, Vol: 14, Pages: 1091-1093
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