scholarly journals The Prepare for Kidney Care Study: prepare for renal dialysis versus responsive management in advanced chronic kidney disease

Author(s):  
Emma Murphy ◽  
Aine Burns ◽  
Fliss E M Murtagh ◽  
Leila Rooshenas ◽  
Fergus J Caskey

Abstract Shared decision making in advanced chronic kidney disease (CKD) requires unbiased information on survival and person-centred outcomes known to matter to patients: quality of life, symptom burden and support from family and healthcare professionals. To date, when deciding between dialysis and conservative care, patients have had to rely on evidence from small observational studies. Clinicians recognize that like is not being compared with like in these studies, and interpret the results differently. Furthermore, support differs considerably between renal units. What patients choose therefore depends on which renal unit they attend. To address this, a programme of work has been underway in the UK. After reports on survival and symptoms from a small number of renal units, a national, mixed-methods study—the Conservative Kidney Management Assessment of Practice Patterns Study—mapped out conservative care practices and attitudes in the UK. This led to the Prepare for Kidney Care study, a randomized controlled trial comparing preparation for dialysis versus preparation for conservative care. Although powered to detect a positivist 0.345 difference in quality-adjusted life years between the two treatments, this trial also takes a realist approach with a range of person-centred secondary outcomes and embedded qualitative research. To understand generalizability, it is nested in an observational cohort study, which is nested in a CKD registry. Challenges to recruitment and retention have been rapidly identified and addressed using an established embedded mixed methods approach—the QuinteT recruitment intervention. This review considers the background to and progress with recruitment to the trial.

The number of patients with advanced kidney disease requiring dialysis is increasing in all parts of the world. Managing patients as they transition onto dialysis and providing support and guidance as they make important treatment choices are essential components of a nephrologist’s job. Ensuring timely preparation for dialysis, allowing patients the opportunity to explore all options, including conservative care, and managing individual expectations of dialysis are increasingly important. All nephrologists will manage patients treated with dialysis and therefore it is imperative that they have a sound understanding of different dialysis modalities, how to assess the adequacy of dialysis, and the commonly encountered medical problems dialysis patients experience.


2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Wouter R. Verberne ◽  
Janneke Dijkers ◽  
Johannes C. Kelder ◽  
Wilbert T. Jellema ◽  
Johannes J. M. van Delden ◽  
...  

Abstract Objective Non-dialytic conservative care is argued to be a reasonable treatment alternative for dialysis in selected older patients with advanced chronic kidney disease. We evaluated patient-relevant outcomes including health-related quality of life in a previous study. However, the scoring algorithm we used to calculate the physical and mental component summary scores of the Short Form-36 (SF-36) turned out to differ from comparable studies on this topic. The aim of this critical appraisal was to reanalyze the SF-36 summary scores in our patient cohort (≥ 70 years) using the more widely used scoring algorithm. Results Patients on conservative care (n = 23) had lower physical and mental component summary scores compared to patients not yet started on dialysis (n = 39), but similar compared to patients on dialysis (n = 34). These findings were similar to our original findings and did not change the conclusions. Several scoring algorithms are used for the SF-36 summary scores. Researchers should be aware of this fact and should use the same scoring algorithm across similar studies in a specific field to increase comparability. Using the more widely used scoring algorithm, the recalculated SF-36 summary scores of our patient cohort can now be compared to other studies.


2016 ◽  
Vol 36 (3) ◽  
pp. 283-291
Author(s):  
Yeleine Martínez Echevers ◽  
Néstor Gabriel Toapanta Gaibor ◽  
Nathasha Nava Pérez ◽  
Francisco Barbosa Martin ◽  
Rafael Montes Delgado ◽  
...  

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Wouter R. Verberne ◽  
Janneke Dijkers ◽  
Johannes C. Kelder ◽  
Anthonius B. M. Geers ◽  
Wilbert T. Jellema ◽  
...  

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii4-ii10 ◽  
Author(s):  
Marie Evans ◽  
Kai Lopau

Abstract People with advanced chronic kidney disease and evidence of progression have a high risk of renal replacement therapy. Specialized transition clinics could offer a better option for preparing these patients for dialysis, transplantation or conservative care. This review focuses on the different aspects of such transition clinics. We discuss which patients should be referred to these units and when referral should take place. Patient involvement in the decision-making process is important and requires unbiased patient education. There are many themes, both patient-centred and within the healthcare structure, that will influence the process of shared decision-making and the modality choice. Aspects of placing an access for haemodialysis and peritoneal dialysis are reviewed. Finally, we discuss the importance of pre-emptive transplantation and a planned dialysis start, all with a focus on multidisciplinary collaboration at the transition clinic.


Sign in / Sign up

Export Citation Format

Share Document