Publications
300 results found
Sulemane S, Panoulas VF, Bratsas A, et al., 2017, Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction, INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol: 33, Pages: 687-698, ISSN: 1569-5794
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
Segall L, Nistor I, Van Biesen W, et al., 2017, Dialysis modality choice in elderly patients with end-stage renal disease: a narrative review of the available evidence, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 32, Pages: 41-49, ISSN: 0931-0509
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- Citations: 33
Tong A, Manns B, Hemmelgarn B, et al., 2017, Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop., Pages: 97-107
Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes.
Brown EA, Bekker HL, Davison SN, et al., 2016, Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 11, Pages: 1902-1908, ISSN: 1555-9041
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- Citations: 46
Bartholomew C, Jones C, Brown E, 2016, CKD and frailty: outcomes from a quality initiative for older patients, Journal of Kidney Care, Vol: 1, Pages: 153-157, ISSN: 2397-9534
Brown EA, Wilkie M, 2016, Assisted Peritoneal Dialysis as an Alternative to In-Center Hemodialysis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 11, Pages: 1522-1524, ISSN: 1555-9041
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- Citations: 26
Wilkinson E, Randhawa G, Brown E, et al., 2016, Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research., BMC Palliat Care, Vol: 15
BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data h
van der Veer SN, van Biesen W, Bernaert P, et al., 2016, Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults, INTERNATIONAL UROLOGY AND NEPHROLOGY, Vol: 48, Pages: 859-869, ISSN: 0301-1623
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- Citations: 11
Finkelstein FO, Zhao J, Bieber B, et al., 2016, INTERNATIONAL VARIATIONS IN THE EXPERIENCE OF PATIENTS ON PERITONEAL DIALYSIS (PD) IN THE PERITONEAL DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (PDOPPS), 53rd ERA-EDTA Congress, Publisher: OXFORD UNIV PRESS, Pages: 239-240, ISSN: 0931-0509
Sulemane S, Panoulas VF, Konstantinou K, et al., 2016, Erratum to: ‘Left ventricular twist mechanics and its relation with aortic stiffness in chronic kidney disease patients without overt cardiovascular disease’, Cardiovascular Ultrasound, Vol: 14, ISSN: 1476-7120
Sulemane S, Panoulas VF, Konstantinou K, et al., 2016, Left ventricular twist mechanics and its relation with aortic stiffness in chronic kidney disease patients without overt cardiovascular disease., Cardiovascular Ultrasound, Vol: 14, ISSN: 1476-7120
BACKGROUND: Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, however its relationship with aortic stiffness has yet to be investigated. Chronic kidney disease (CKD) has been identified as a risk factor for both myocardial and arterial disease. As such we sought to explore the relationship between aortic stiffness and LV twist in CKD patients without known cardiovascular disease (CVD). METHODS: In this prospective, observational study we enrolled 106 CKD patients (Stages 1 to 5) with normal LVEF as assessed by conventional echocardiography. Aortic stiffness was measured using aortic pulse wave velocity (aPWV). We defined increased aPWV as ≥10 m/s. LV Twist was measured using two-dimensional speckle tracking echocardiography. RESULTS: Patients with increased aPWV had higher LV twist (p = 0.002) but similar LVEF (p = 0.486). Aortic PWV correlated crudely with age (p < 0.001), the presence of diabetes (p < 0.001), hypertension (p < 0.001), eGFR (p < 0.001), LVMI (p = 0.01), e/e' (p < 0.001) and LV twist (p = 0.003). In multivariable analyses after adjusting for age, gender, cardiovascular risk factors and hypertensive medication, aPWV was independently associated with LV twist (β = 0.163, p = 0.025). CONCLUSIONS: Aortic stiffness independently associates with LV Twist in asymptomatic CKD patients. These findings suggest a close interaction between LV twist mechanics and arterial remodeling even before CVD becomes clinically relevant.
Lyasere OU, Brown EA, Johansson L, et al., 2016, Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 11, Pages: 423-430, ISSN: 1555-9041
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- Citations: 149
Levy J, Brown E, Lawrence A, 2016, Oxford Handbook of Dialysis
<p>The <italic>Oxford Handbook of Dialysis</italic> is a comprehensive and practical guide to all aspects of dialysis, and the management of patients with end-stage kidney disease and all its complications. The current edition has been completely updated, and covers all haemodialysis techniques; haemodiafiltration; home and frequent dialysis; peritoneal dialysis; plasma exchange; the medical, nursing, and psychosocial aspects of managing patients with end-stage kidney failure; acute management of renal transplantation particularly with reference to dialysis patients; palliative care in renal disease; and drug dosing guidelines. Bone disease, anaemia, cardiovascular disease, infections, pain, end-of-life care, and the widespread complications of chronic kidney disease are discussed, with practical guidance and management, presented in a compact and easy-to-use format. The book is aimed at all healthcare professionals dealing with dialysis patients from nephrologists to dieticians, pharmacists, nurses, counsellors, intensivists, and surgeons, and there are specific chapters on nursing patients on haemodialysis and peritoneal dialysis, and detailed nutrition and drug prescribing chapters. The current edition includes new sections on renal replacement therapies in acute kidney injury, home dialysis, new peritoneal dialysis fluids, new drugs including new epoetins and phosphate binders, and updated sections on nocturnal dialysis, dialysis monitoring, encapsulating peritoneal sclerosis, sleep disorders. The book is clearly subdivided, easy to read, very practical, specific, and focussed, with individual topics covered on one or two pages with room for extra notes throughout. We hope this book should have a home in every renal unit, dialysis centre, renal ward, and close to hand for every nephrologist, renal trainee, renal nurse, dietician technician, and pharmacist</p>
van Biesen W, van de Luijtgaarden MWM, Brown EA, et al., 2015, Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 30, Pages: 1951-1958, ISSN: 0931-0509
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- Citations: 38
Burkhalter F, Clemenger M, San Haddoub S, et al., 2015, <i>Pseudomonas</i> exit-site infection: treatment outcomes with topical gentamicin in addition to systemic antibiotics, CLINICAL KIDNEY JOURNAL, Vol: 8, Pages: 781-784, ISSN: 1753-0784
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- Citations: 10
Meeus F, Brown EA, 2015, Caring for Older Patients on Peritoneal Dialysis at End of Life, Peritoneal Dialysis International, Vol: 35, Pages: 667-670, ISSN: 0896-8608
End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and their family to determine lifestyle goals, treatment wishes, and ceilings of care (including resuscitation and dialysis withdrawal). Care should also include symptom identification and management, psychosocial support, and adaptation of dialysis to the ability and needs of the patient. By doing this, quality of life at end of life is achievable.
Brown EA, Bargman JM, Li PKT, 2015, MANAGING OLDER PATIENTS ON PERITONEAL DIALYSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 35, Pages: 609-611, ISSN: 0896-8608
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- Citations: 9
Davison SN, Levin A, Moss AH, et al., 2015, Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care, KIDNEY INTERNATIONAL, Vol: 88, Pages: 447-459, ISSN: 0085-2538
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- Citations: 316
Brown EA, 2015, Maximal conservative management, Medicine (United Kingdom), Vol: 43, Pages: 493-495, ISSN: 1357-3039
The aim of renal replacement therapy (RRT) is to prolong the quantity of life without diminishing the quality of remaining years. Unfortunately, in some patients, this is far from reality. Maximal conservative management is the support of patients with end-stage kidney disease (ESKD) without resorting to RRT. This support addresses the patient's physical, emotional and spiritual needs until the end of life: a multidisciplinary approach is therefore essential. Medical therapy includes the treatment of underlying renal pathology and other manoeuvres to prolong residual renal function, such as anti-hypertensive medication. As renal function declines, the treatment of renal anaemia with erythropoietin and optimization of fluid balance with diuretics can become more important. Pain control must be achieved but can be problematic in ESKD because of decreased elimination of drugs and their metabolites: various strategies are discussed. There are some data to suggest that selected patients with high co-morbidity live just as long with maximal conservative management as if they had dialysis. However, to withhold RRT from all patients with multiple co-morbidities would be ethically questionable. The decision to opt for non-dialysis medical therapy or conservative care should be made only after shared decision making between the patient, their families and the healthcare team.
Brown E, 2015, Peritoneal dialysis: older patients report better quality of life than younger., Evid Based Nurs, Vol: 18
Iyasere O, Brown EA, 2015, Mortality in the Elderly on Dialysis: Is This the Right Debate?, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 10, Pages: 920-922, ISSN: 1555-9041
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- Citations: 18
Singh S, Power A, Brown E, 2015, EXTENDED TREATMENT TIME ON HAEMODIALYSIS IS ASSOCIATED WITH IMPROVED BLOOD PRESSURE CONTROL, NUTRITIONAL STATUS AND REDUCED TIME TO RECOVERY, 52nd Congress of the European-Renal-Association-European-Dialysis-and-Transplant-Assocation, Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Singh S, Procter S, Power A, et al., 2015, SURVEY OF STAFF OPINIONS ABOUT EXTENDED HAEMODIALYSIS TREATMENT TIME AND SERVICE IMPLICATIONS., Journal of Renal Care, Vol: 41, Pages: 162-167, ISSN: 1755-6686
We explored the potential impact of staff opinions and service provision upon patient's willingness to recruit to a clinical trial studying the effects of extended treatment time (TT) on haemodialysis (HD), six hours versus four hours for a period of twenty-four weeks.
Koizia L, Brown E, 2015, Pain management in renal in-patients: How good are medical teams on renal wards at prescribing analgesia?, British Renal Society
Brown EA, 2015, Peritoneal dialysis for the elderly, Dialysis in Older Adults: A Clinical Handbook, Pages: 57-65, ISBN: 9781493933181
The default dialysis choice for the elderly is usually haemodialysis in most European countries, Canada and the USA with relatively few patients starting on peritoneal dialysis (PD) compared to younger and fitter patients. This is actually quite surprising as a home-based treatment avoids the need for transport and peritoneal dialysis (PD) does not have the haemodynamic swings associated with haemodialysis (HD). There is no doubt that there are often challenges to enabling an elderly patient to have PD, but the development of assisted PD can surmount many of these. Indeed, in France where assisted PD has been available for many years, the PD population is predominantly elderly [1]. As discussed in Chapter (Choosing Dialysis Modality), the BOLDE study has shown that PD patients have less illness and treatment intrusion than patients on HD [2], though the patients in the study were mainly fitter older patients and none were on assisted PD.
Johansson L, Brown EA, 2015, How to choose the type of dialysis in the elderly patient, Dialysis in Older Adults: A Clinical Handbook, Pages: 9-19, ISBN: 9781493933181
Only a few patients over the age of 70 will be eligible for transplantation, so the older patient starting dialysis will remain on this treatment for the rest of their life. Choice of dialysis modality will not affect patient survival but will have a major impact on patient lifestyle and therefore quality of life. The decision about dialysis modality is therefore a crucially important one, and the choice should be made with the patient. This requires the clinician (nephrologist, dialysis educator, etc.) to have a realistic understanding about life on haemodialysis (HD) and peritoneal dialysis (PD) for older people in general and for the patient in particular. The patient (and family/carers) also needs appropriate unbiased education about the pros and cons of HD and PD and how both will affect their lifestyle and overall prognosis. This process is called “shared decision making”. To ensure that this happens with each patient about to start patient, it is useful to break the process down into a series of steps as shown in Table 2.1.
Brown EA, 2014, Ethnic and cultural challenges at the end of life: setting the scene., J Ren Care, Vol: 40 Suppl 1, Pages: 2-5
Patients with advanced kidney disease come from diverse ethnic, cultural and religious backgrounds. This potentially causes conflict when considering end-of-life management for patients from minority ethnic groups in a Western healthcare system that is dominated by the principles of patient autonomy, beneficence, non-maleficence and avoiding futile care. This article explores the impact of religion and culture on truth telling and futile care at end of life.
Brown EA, 2014, Supportive care for people with kidney disease: ethnic and cultural challenges., J Ren Care, Vol: 40 Suppl 1
Wilkinson E, Randhawa G, Brown EA, et al., 2014, Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK., J Ren Care, Vol: 40 Suppl 1, Pages: 23-29
South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues.
Iyasere O, Brown EA, 2014, Determinants of quality of life in advanced kidney disease: time to screen?, POSTGRADUATE MEDICAL JOURNAL, Vol: 90, Pages: 340-347, ISSN: 0032-5473
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- Citations: 25
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