ORCID Profile
0000-0001-5163-4351
Current Organisation
The University of Auckland
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Publisher: Wiley
Date: 03-02-2022
DOI: 10.1111/NEP.14025
Publisher: Wiley
Date: 19-11-2014
DOI: 10.1002/JORC.12043
Abstract: Peritoneal dialysis (PD) has been shown to offer a high quality of life and independence to patients. New Zealand (NZ) is a world leader in home dialysis, yet over the last decade, rates of PD have been steadily decreasing for unknown reasons. This paper reports on the findings of a national survey which explored the clinicians' perspectives on key factors that influence the rate of PD. Ten multi-answer questions were asked of several groups of dialysis health professionals to assess factors that are barriers and enablers to PD, including patient choice of dialysis modality, information about PD and pre-dialysis education delivery. All NZ nephrologists, pre-dialysis and PD nurses were invited to complete an anonymous online survey. Responses were analysed to identify perceived barriers and enablers influencing the rate of PD uptake amongst incident dialysis patients. Completed surveys were received from 52% of nephrologists, 100% of pre-dialysis nurses and 50% of PD nurses in NZ. In NZ, patients are offered a choice of dialysis modality with pre-dialysis nurses delivering the majority of education. The most frequently identified barriers to uptake of PD were lack of information about PD, established misconceptions about PD and late referrals to dialysis. Important enablers were early and frequent pre-dialysis education. The only two factors which were reported as very important contraindications to PD were dexterity and decreased cognitive function. Early and frequent pre-dialysis education encourages patients to choose PD and enables early identification and resolution of barriers to the uptake of PD.
Publisher: SAGE Publications
Date: 07-12-2022
DOI: 10.1177/08968608221136389
Abstract: When a patient on peritoneal dialysis (PD) presents with suspected PD-related peritonitis (e.g. cloudy PD fluid and abdominal pain), one of the most important initial aspects of management is for the nephrology nurse/home dialysis nurse to collect PD effluent specimens for white blood cells count, Gram stain, culture and sensitivity for inspection and to send for laboratory testing before antibiotics are started. A review by seven members of the International Society for Peritoneal Dialysis (ISPD) Nursing Committee of all 133 questions posted to the ISPD website ‘Questions about PD’ over the last 4 years (January 2018–December 2021), revealed 97 posted by nephrology nurses from around the world. Of these 97 questions, 10 were noted to be related to best practices for PD effluent specimen collection. For our review, we focused on these 10 questions along with their responses by the members of the ISPD ‘Ask The Experts Team’, whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practice discussed. We revised the original responses for clarity and updated the references. We found that these 10 questions were quite varied but could be organised into four categories: how to collect PD effluent safely how to proceed with PD effluent collection how to collect PD effluent for assessment and how to proceed with follow-up PD effluent collection after intraperitoneal antibiotics have been started. In general, we found that there was limited evidence in the PD literature to answer several of these 10 questions posted to the ISPD website ‘Questions about PD’ by nephrology nurses from around the world on this important clinical topic of best practices for PD effluent specimen collection. Some of these questions were also not addressed in the latest ISPD Peritonitis Guidelines. Moreover, when polling members of our ISPD Nursing Committee we found when answering a few of these questions, nursing practice varied within and among countries. We encourage PD nurses to conduct their own research on this important topic, focusing on areas where research evidence is lacking.
Publisher: Oxford University Press (OUP)
Date: 27-06-2022
DOI: 10.1093/NDT/GFAB207
Abstract: Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses. Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals. Death from dialysis withdrawal accounted for & % of early deaths in kidney failure patients initiated on dialysis and remained unchanged over the past two decades. Several shared risk factors were observed between mortality attributed to early psychosocial and medical withdrawals.
Publisher: Springer Science and Business Media LLC
Date: 04-02-2019
DOI: 10.1007/S40258-018-00455-2
Abstract: The economic burden of providing maintenance dialysis to those with end-stage kidney disease continues to increase. Home dialysis, including both haemodialysis and peritoneal dialysis, is commonly assumed to be more cost effective than facility dialysis, with some countries adopting a home-first policy in an attempt to reduce costs. However, the cost effectiveness of this approach is uncertain. The aim of this study is to review all published cost-effectiveness analyses comparing all alternative dialysis modalities for people with end-stage kidney disease. We conducted a systematic review of MEDLINE, the National Health Service Economic Evaluation Database, and Health Technology Assessment Database from the Centre of Reviews and Dissemination, The Cochrane Library and Econlit from January 2000 to December 2017. Published economic evaluations were included if they provided comparative information on the costs and health outcomes of alternative dialysis modalities. The review identified 16 economic evaluations comparing dialysis modalities from both high- and low-income countries. The majority (69%) were undertaken solely from the perspective of the payer or service provider, 14 (88%) included a cost-utility analysis and eight (50%) were modelled evaluations. The studies addressed costs and health outcomes of multiple dialysis modalities, with many reporting average cost effectiveness rather than incremental cost effectiveness. Almost all evaluations suggest home dialysis to be less costly and to offer comparable or better health outcomes than in-centre haemodialysis. However, the quality-of-life benefit for each modality was poorly defined and inconsistent in terms of magnitude and direction of differences between modalities and across studies. Other issues include exclusion of competing modalities and use of arbitrary assumptions with regard to the mix of modalities. The ability to identify the mix of dialysis modalities that provides best outcomes for patients and health budgets is uncertain particularly given the lack of societal perspectives and inconsistencies between published studies.
Publisher: Elsevier BV
Date: 03-2020
Publisher: SAGE Publications
Date: 10-05-2022
DOI: 10.1177/08968608221096560
Abstract: Life participation is an outcome of critical importance to patients receiving peritoneal dialysis (PD). However, there is no widely accepted or validated tool for measuring life participation in patients receiving PD. Online consensus workshop to identify the essential characteristics of life participation as a core outcome, with the goal of establishing a patient-reported outcome measure for use in all trials in patients receiving PD. Thematic analysis of transcripts was performed. Fifty-six participants, including 17 patients and caregivers, from 15 countries convened via online videoconference. Four themes were identified: reconfiguring expectations of daily living (accepting day-to-day fluctuation as the norm, shifting thresholds of acceptability, preserving gains in flexibility and freedom), ensuring broad applicability and interpretability (establishing cross-cultural relevance, incorporating valued activities, distinguishing unmodifiable barriers to life participation), capturing transitions between modalities and how they affect life participation (responsive to trajectory towards stable, reflecting changes with dialysis transitions) and maximising feasibility of implementation (reducing completion burden, administrable with ease and flexibility). There is a need for a validated, generalisable outcome measure for life participation in patients receiving PD. Feasibility, including length of time to complete and flexible mode of delivery, are important to allow implementation in all trials that include patients receiving PD.
Publisher: Oxford University Press (OUP)
Date: 07-09-2016
DOI: 10.1093/NDT/GFV330
Abstract: Home dialysis can offer improved quality of life and economic benefits compared with facility dialysis. Yet the uptake of home dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering home dialysis, to inform strategies to align policy and practice with patients' needs. Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. In total, 43 patients [pre-dialysis (n = 18), peritoneal dialysis (n = 13), home haemodialysis (n = 4) and facility haemodialysis (n = 9)] and 9 caregivers participated. We identified five themes related to home dialysis: lacking decisional power (complexity of information, limited exposure to home dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. To engage and empower patients and caregivers to consider home dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-dialysis and home dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake home dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2022
Publisher: Informa UK Limited
Date: 03-07-2020
Publisher: SAGE Publications
Date: 22-04-2021
Abstract: A differential association between mortality and cause of end-stage kidney disease in patients with type 2 diabetes mellitus (T2DM) has been shown. Sex-specific differences in diabetes-related complications have been described. It is unclear whether sex affects the associations between diabetes and peritoneal dialysis (PD) technique and patient survival. Using the Australia and New Zealand Dialysis and Transplant Registry, we examined a two-way interaction between sex and diabetes status (no diabetes, T2DM and non-diabetic nephropathy [T2DM + non-DN] and T2DM and diabetic nephropathy [T2DM + DN]) for PD technique failure (including death), all-cause mortality and cause-specific mortality in incident adult PD patients between 1996 and 2016 using adjusted Cox regression. Mediation analysis was conducted to determine whether peritonitis was a mediator in these associations. In 8279 PD patients, those with T2DM + DN had the greatest risks in technique failure, all-cause mortality and cause-specific mortality followed by patients with T2DM + non-DN, then patients without diabetes. Sex modified the association with diabetes status in technique failure ( p interaction = 0.001) and cardiac mortality ( p interaction = 0.008). In women with T2DM + DN, the adjusted hazard ratio (HR) for technique failure was 1.45 (1.30–1.62) and was higher than men with T2DM + DN (1.17 [1.08–1.28] referent: no diabetes). In women with T2DM + DN, the adjusted HR for cardiac mortality was 2.12 (1.73–2.61) and was also higher than men with T2DM + DN (1.66 [1.43–1.95]). Less than 10 % of the effect between diabetes and PD technique failure or mortality was mediated by peritonitis. PD patients with diabetic nephropathy had increased risk of PD technique failure and mortality, with the magnitude of these risks greater in women.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2022
Publisher: Oxford University Press (OUP)
Date: 26-12-2021
DOI: 10.1093/NDT/GFAA244
Abstract: Patients receiving peritoneal dialysis (PD) endure an ongoing regimen of daily fluid exchanges and are at risk of potentially life-threatening complications and debilitating symptoms that can limit their ability to participate in life activities. The aim of the study was to identify the characteristics, content and psychometric properties of measures for life participation used in research in PD. We searched MEDLINE, Embase, PsychInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials from inception to May 2020 for all studies that reported life participation in patients on PD. The characteristics, dimensions of life participation and psychometric properties of these measures were extracted and analyzed. Of the 301 studies included, 17 (6%) were randomized studies and 284 (94%) were nonrandomized studies. Forty-two different measures were used to assess life participation. Of these, 23 (55%) were used in only one study. Fifteen (36%) measures were specifically designed to assess life participation, while 27 (64%) measures assessed broader constructs, such as quality of life, but included questions on life participation. The 36-Item Short Form Health Survey and Kidney Disease Quality of Life Short Form were the most frequently used measures [122 (41%) and 86 (29%) studies, respectively]. Eight (19%) measures had validation data to support their use in patients on PD. The many measures currently used to assess life participation in patients receiving PD vary in their characteristics, content and validation. Further work to pilot and validate potential measures is required to establish a core patient-reported outcome measure to assess life participation in patients receiving PD.
Publisher: Wiley
Date: 22-04-2019
DOI: 10.1111/NEP.13405
Abstract: Kidney transplantation offers improved quality of life and life expectancy compared with dialysis for children. This study aims to understand the experiences and expectations of children during the kidney transplantation process to inform clinical care. Face-to-face, semi-structured interviews were conducted with 13 children and adolescents aged between 7 and 17 years in New Zealand who had received a kidney transplantation. Findings were conceptualized using thematic analysis with inductive coding. Three major themes were identified: transplant as the goal (the only real treatment and escaping dialysis) dealing with negative emotions (coping with anxiety and fear, guilt for siblings and burden of parent as donor) and enhancing understanding and knowledge (in idualised education and reassurance from peer support). Children and adolescents view transplantation as freedom from dialysis and return to a more normal life. Children focus on the positive aspects of transplantation to reduce anxiety and be reassured in the face of uncertainty. Complex emotions arise when thinking about their donor. Children recognize transplantation is not a return to full health and actively seek out ways to self-manage their care, while remaining anxious about their future.
Publisher: Informa UK Limited
Date: 08-2012
DOI: 10.5172/CONU.2012.42.1.28
Abstract: With the increasing burden of chronic kidney disease (CKD) in New Zealand (NZ) the number of people requiring pre-dialysis care is increasing. Pre-dialysis nurses play a central role in the delivery of this care. This paper describes and discusses what pre-dialysis nurses perceive to be key influences on effective pre-dialysis nursing care in NZ. It is based on findings from a wider qualitative study that interviewed the majority of NZ pre-dialysis nurses. Following inductive data analysis four main influences were identified. They were: having time from referral to commencement of renal replacement therapy (RRT) to provide adequate education and support having good access to cultural and other supports and an understanding of differing cultural views of health the importance of good inter-professional relationships and support from nursing management and doctors to advance professionally. With the knowledge of the projected increase in patients with CKD, we argue that it is important to ensure the positive aspects of these influences are enhanced in order to ensure effective pre-dialysis nursing care, nurse satisfaction and professional advancement.
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/HDI.12203
Abstract: The key to developing, initiating, and maintaining a strong home dialysis program is a fundamental commitment by the entire team to identify and cultivate patients who are suitable candidates to perform home dialysis. This process must start as early as possible in the disease trajectory, and must include a passionate and daily focus by physicians, nurses, social workers, and other members of the multidisciplinary team. This effort must be constant and sustained over months, with active promotion of home dialysis for suitable patients at every opportunity. Cultivation of suitable patients must become a defining and overarching mission for the entire program. This article reviews some of the components involved in this worthwhile effort and provides practical tips and links to resources.
Publisher: Springer Science and Business Media LLC
Date: 07-06-2019
Publisher: SAGE Publications
Date: 17-01-2020
Abstract: Fear of catastrophic events and uncertainty about safety at home are barriers to choosing peritoneal dialysis (PD). Remote monitoring may address these concerns and is increasingly being used in patients on automated peritoneal dialysis (APD). This study aims to describe clinicians’ perspectives and experiences of remote monitoring in caring for patients on PD. We conducted semi-structured interviews with nephrologists and dialysis nurses across nine dialysis units in New Zealand who had experience using remote monitoring with patients on APD. Interviews were transcribed and analysed using thematic analysis. Thirteen registered nurses and 12 nephrologists or nephrologists-in-training (total N = 25) participated. Four themes were identified: promoting and maintaining PD (providing reassurance to patients through continual surveillance, supporting confidence at home and sustaining PD as the patient-preferred treatment) enabling data-driven decisions (using comprehensive clinical data in providing timely and accessible care, and identifying and supporting patient adherence) establishing boundaries for use (negotiating privacy and independence, clarifying clinician and patient responsibilities and strengthening nursing innovation and capability) and enhancing patient-focused care (developing empathy for patients, enabling self-management and reducing time and financial burden in accessing care). Remote monitoring is valued by clinicians in promoting and maintaining patients on PD and enabling data-driven decisions. Remote monitoring enhances patient-focused care, but clinicians also emphasise the need to protect patient privacy and establish boundaries for use. Remote monitoring that supports the clinicians’ role and adheres to principles of data security maintains patient privacy may enhance care and outcomes for patients on PD.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.IJMEDINF.2019.01.013
Abstract: To describe the range of patients' beliefs, attitudes, expectations, and experiences of remote monitoring for chronic conditions across different healthcare contexts and populations. We searched MEDLINE, Embase, PsychINFO, and CINAHL, Google Scholar, and reference lists of related studies through to July 2017. Thematic synthesis was used to analyse the findings of the primary studies. Study characteristics were examined to explain differences in findings. All healthcare settings PARTICIPANTS: Adults with chronic diseases OUTCOMES: Patient beliefs, attitudes, expectations and experiences of remote monitoring RESULTS: We included 16 studies involving 307 participants with chronic obstructive pulmonary disease, heart failure, diabetes, hypertension, and end stage kidney disease. The studies were conducted in 8 countries. We identified four themes: gaining knowledge and triggering actions (tracking and responding to change, prompting timely and accessible care, supporting self-management and shared decision-making) reassurance and security (safety in being alone, peace of mind) concern about additional burden (reluctance to learn something new, lack of trust in technology, avoiding additional out-of-pocket costs), and jeopardising interpersonal connections (fear of being lost in data, losing face to face contact). For patients with chronic disease, remote monitoring increased their disease-specific knowledge, triggered earlier clinical assessment and treatment, improved self-management and shared decision-making. However, these potential benefits were balanced against concerns about losing interpersonal contact, and the additional personal responsibility of remote monitoring.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2019
Publisher: BMJ
Date: 2017
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1053/J.AJKD.2021.12.007
Abstract: Patients receiving hemodialysis experience high symptom burden and low quality of life (QOL). Electronic patient-reported outcome measures (e-PROMs) monitoring with feedback to clinicians may be an acceptable intervention to improve health-related QOL for patients receiving hemodialysis. This study explored patient and clinician perspectives on e-PROMs monitoring with feedback to clinicians. Qualitative study. 41 participants (12 patients, 13 nephrologists, 16 dialysis nurses) who participated in a 6-month feasibility pilot study of adults receiving facility-based hemodialysis across 4 Australian units. The intervention consisted of electronic symptom monitoring with feedback to clinicians, who also received evidence-based symptom management recommendations to improve health-related QOL. Semistructured interviews and focus group discussions explored the feasibility and acceptability of e-PROMs monitoring with feedback to clinicians. We conducted a thematic analysis of transcripts. We identified 4 themes: enabling efficient, systematic, and multidisciplinary patient-centered care experiencing limited data and options for symptom management requiring familiarity with technology and processes and identifying barriers and competing priorities. While insufficient patient engagement, logistic/technical challenges, and delayed symptom feedback emerged as barriers to implementation, active engagement by nurses in encouraging and supporting patients during survey completion and clinicians' prompt action after symptom feedback were considered to be facilitators to implementation. Limited generalizability due to inclusion of English-speaking participants only. Patients, nurses, and nephrologists considered e-PROMs monitoring with feedback to clinicians feasible for symptom management in hemodialysis. Clinician engagement, patient support, reliable technology, timely symptom feedback, and interventions to address symptom burden are likely to improve its implementation within research and clinical settings.
Publisher: Public Library of Science (PLoS)
Date: 07-05-2014
Publisher: Frontiers Media SA
Date: 14-09-2021
DOI: 10.1111/TRI.14002
Abstract: Social disparity is a major impediment to optimal health outcomes after kidney transplantation. In this study, we aimed to define the association between socio-economic status (SES) disparities and patient-relevant outcomes after kidney allograft failure. Using data from the Australia and New Zealand Dialysis and Transplant registry, we included patients with failed first-kidney allografts in Australia between 2005 and 2017. The association between residential postcode-derived SES in quintiles (quintile 1-most disadvantaged areas, quintile 5-most advantaged areas) with uptake of home dialysis (peritoneal or home haemodialysis) within the first 12-months post-allograft failure, repeat transplantation and death on dialysis were examined using competing-risk analysis. Of 2175 patients who had experienced first allograft failure, 417(19%) and 505(23%) patients were of SES quintiles 1 and 5, respectively. Compared to patients of quintile 5, quintile 1 patients were less likely to receive repeat transplants (adjusted subdistributional hazard ratio [SHR] 0.70,95%CI 0.55-0.89) and were more likely to die on dialysis (1.37 [1.04-1.81]), but there was no association with the uptake of home dialysis (1.02 [0.77-1.35]). Low SES may have a negative effect on outcomes post-allograft failure and further research is required into how best to mitigate this. However, small-scale variation within SES cannot be accounted for in this study.
Publisher: Wiley
Date: 11-07-2019
DOI: 10.1111/JORC.12292
Abstract: Kidney transplantation offers greater life expectancy, quality of life and participation compared with dialysis, in children with end stage kidney disease. This study explores the perspectives and experiences of parents of children undergoing kidney transplantation, as the experiences of parents in the process of transplantation is not completely understood. Face-to-face semi-structured interviews were conducted with parents of transplanted children across New Zealand. Data were analysed using thematic analysis to identify themes of participant experiences and perspectives. We interviewed 13 mothers and four fathers of the transplanted children. Four themes were identified: actively pursuing transplant (the urgency of transplant needing to drive the transplantation process) lack of on-going support (needing access to specialists feeling unprepared for demands of transplantation, and vulnerability of unmet emotional concerns), pressure on the family unit (strain of distance disrupting parent team added burden of parent as donor financial stress) and constant concern for the future (living with enduring uncertainty pressure of responsibility apprehension of teenage years). Parents of children need to play an active role in advocating and driving the transplantation process. Transplantation leads to parental role disruption, emotional and financial stress, and insecurity about the future for their child. These findings suggest the need for greater communication and transparency in the transplantation process with parents, improved emotional and financial support for families during and after transplantation, and explicit assistance for parental roles in families when a caregiver is the donor.
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/HDI.12283
Abstract: This special supplement of Hemodialysis International focuses on home hemodialysis (HD). It has been compiled by a group of international experts in home HD who were brought together throughout 2013-2014 to construct a home HD "manual." Drawing upon both the literature and their own extensive expertise, these experts have helped develop this supplement that now stands as an A-to-Z guide for any who may be unfamiliar or uncertain about how to establish and maintain a successful home HD program.
Publisher: Wiley
Date: 16-11-2017
DOI: 10.1111/NEP.12920
Abstract: There is little research exploring the association between clinicians' behaviours and home dialysis uptake. This paper aims to better understand the influence of clinicians on home dialysis modality recommendations and uptake. Online survey of all NZ renal units to determine the influence of in iduals within pre-dialysis teams. We used the self-declaration scale of influence to rate the identified member's perceived influence on decision-making. We used this measure of 'decisional power' to compare the perceived influence of pre-dialysis nurses with nephrologists using both parametric and non-parametric methods. We developed a generalized linear model to investigate the relationship between the influence of nephrologists and pre-dialysis nurses with home dialysis uptake by in idual centre using additional data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Finally, respondents rated the importance of a list of patient and service-level factors in recommendations for home dialysis. Data suggest the nephrologists are the most influential member of the pre-dialysis team. This contrasts with perceptions of survey respondents who view pre-dialysis nurses as most influential. Nephrologists' recommendations are likely to be a successful way of increasing home dialysis. A single point increase in nephrologist decisional power is associated with a 6.1% increase in the prevalence of home dialysis. The decisional power around home dialysis in NZ sits with nephrologists. It is therefore critical that nephrologists exercise their decisional power in advocating home dialysis and address reasons why they may not recommend home dialysis to well-suited and appropriate patients.
Publisher: SAGE Publications
Date: 21-10-2020
Abstract: Peritoneal dialysis (PD) can offer more flexibility and independence compared with hemodialysis, yet uptake of PD remains low. Barriers to PD include the fear of dialyzing without medical assistance and uncertainty about recognizing and managing complications. There is increasing use of remote monitoring in automated peritoneal dialysis (APD), but little is known about its acceptability by patients and caregivers. We aimed to describe patients’ and caregivers’ expectations and experiences of remote monitoring for APD. Qualitative study design, using semi-structured face-to-face interviews of patients who either receiving PD or were considered eligible for PD, and their caregivers. Transcripts were analyzed using thematic analysis. Of the 34 participants, 27 were patients and the remainder caregivers. Four themes (with subthemes) were identified reducing patient burden (seeking reassurance and shared responsibility, convenience and accuracy) strengthening partnerships in care (empowering knowledge and understanding, increased accountability to dialysis team) improving access to treatment (saving time and money, providing timely care and avoiding hospital) and preserving quality patient–provider interactions (enhancing face-to-face contact, clarifying expectations of access and use of data). Remote monitoring may increase patient knowledge about their kidney disease and its treatment, encourage accountability to the clinical team, enhance partnerships with clinicians, and improve access to treatment and timely care. It is also important to ensure that remote monitoring does not replace face-to-face clinical contact with clinicians.
Publisher: Wiley
Date: 25-07-2014
DOI: 10.1111/NEP.12269
Abstract: The financial burden of the increasing dialysis population challenges healthcare resources internationally. Home haemodialysis offers many benefits over conventional facility dialysis including superior clinical, patient-centred outcomes and reduced cost. This review updates a previous review, conducted a decade prior, incorporating contemporary home dialysis techniques of frequent and nocturnal dialysis. We sought comparative cost-effectiveness studies of home versus facility haemodialysis (HD) for people with end-stage kidney failure (ESKF). We conducted a systematic review of literature from January 2000-March 2014. Studies were included if they provided comparative information on the costs, health outcomes and cost-effectiveness ratios of home HD and facility HD. We searched medical and health economic databases using MeSH headings and text words for economic evaluation and haemodialysis. Six studies of economic evaluations that compared home to facility HD were identified. Two studies compared home nocturnal HD, one home nocturnal and daily home HD, and three compared contemporary home HD to facility HD. Overall these studies suggest that contemporary home HD modalities are less costly and more effective than facility HD. Home HD start-up costs tend to be higher in the short term, but these are offset by cost savings over the longer term. Contemporaneous dialysis modalities including nocturnal and daily home haemodialysis are cost-effective or cost-saving compared with facility-based haemodialysis. This result is largely driven by lower staff costs, and better health outcomes for survival and quality of life. Expanding the proportion of haemodialysis patients managed at home is likely to produce cost savings.
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000496312
Publisher: Informa UK Limited
Date: 02-2017
DOI: 10.2147/CEOR.S69340
Publisher: Springer Science and Business Media LLC
Date: 22-05-2019
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1053/J.AJKD.2021.12.010
Abstract: In Aotearoa/New Zealand, Indigenous Māori experience inequitable delivery of kidney transplantation despite disproportionately higher rates of kidney failure. This study describes Māori patients' and families' values, perspectives, and experiences related to kidney transplantation. Qualitative interview study. We conducted 40 in-depth interviews of 40 Māori: 8 who had received a transplant, 20 with chronic kidney disease (which included 10 on the deceased donor transplant list, 9 who were interested in transplantation and not currently waitlisted or who were ineligible for waitlisting, and 1 who was not interested in transplantation), 4 live-kidney donors, and 8 family members including 6 who had experiences with donor assessment. Data were analyzed inductively to generate themes and a conceptual framework. We identified 5 major themes: actively seeking a kidney transplant evolving attitudes toward traditional values and practices being confronted by interpersonal and systemic racism poor information and communication and challenged by social determinants of health. Participants were recruited nationally through patient advocacy organizations and 1 regional kidney service. Potential participants unrelated to these groups or region could not be included. Māori participants were highly motivated to seek kidney transplantation and were inspired by positive experiences through donating and receiving a kidney. However, they faced barriers including social determinants, racism, and lack of information that impacted both direct experiences of transplantation and access to transplantation services.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1053/J.AJKD.2012.10.020
Abstract: There is revived interest in home hemodialysis (HD), which is spurred by cost containment and experience indicating lower mortality risk compared with facility HD and peritoneal dialysis (PD). Social barriers to home HD include disruptions to the home environment, interference with family life, overburdening of support networks, and fear of social isolation. A submodality of home HD, in which patients from urban settings undertake independent HD in unstaffed nonmedical community-based home-like settings, is described in this study. The survival of patients treated in this manner is compared with that of those using conventional home HD. An observational cohort study using the Australia and New Zealand Dialysis and Transplant Registry. All adult patients starting renal replacement therapy in New Zealand since March 31, 2000, followed up through December 31, 2010. The main predictor was time-varying dialysis modality (home HD, facility HD, PD, and community house HD), adjusting for the confounding effects of patient demographics and time-varying comorbid conditions. Patient mortality. 4,709 patients with 12,883 patient-years of follow-up (5,591, PD 1,532, home HD 5,647, facility HD and 113, community house HD) were analyzed. Community house HD patients were younger, healthier, and more likely to be Pacific people than those using other modalities, including home HD. Relative to home HD, adjusted mortality HRs were 2.18 (95% CI, 1.78-2.67) for facility HD, 2.17 (95% CI, 1.77-2.66) for PD, and 1.48 (95% CI, 0.64-3.40) for community house HD. Small number of patients receiving community house HD, possible residual confounding from the limited collection of comorbid conditions (eg, no collection of cognitive or motor impairment), and absence of socioeconomic, medication, and biochemical data in analyses. Within limits, this study shows community house HD to be both safe and effective. Community house HD provides an option to improve the uptake of home HD.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.KINT.2018.12.005
Abstract: 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 in iduals from around the globe with erse 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. Ex les 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 health-related suffering of adults and children affected by ESKD worldwide.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1053/J.AJKD.2014.10.020
Abstract: Although home hemodialysis (HD) is associated with better survival compared with hospital HD, the burden of treatment may be intensified for patients and their caregivers and deter patients from this treatment choice. We describe patient and caregiver perspectives and experiences of home HD to inform home HD programs that align with patient preferences. Systematic review of qualitative studies. Adults with chronic kidney disease and caregivers of both home and hospital dialysis patients who expressed opinions about home HD. MEDLINE, EMBASE, PsycINFO, CINAHL, and reference lists were searched to October 2013. Thematic synthesis. 24 studies involving 221 patients (home HD [n=109], hospital HD [n=97], and predialysis [n=15]) and 121 caregivers were eligible. We identified 5 themes: vulnerability of dialyzing independently (fear of self-needling, feeling unqualified, and anticipating catastrophic complications), fear of being alone (social isolation and medical disconnection), concern of family burden (emotional demands on caregivers, imposing responsibility, family involvement, and medicalizing the home), opportunity to thrive (re-establishing a healthy self-identity, gaining control and freedom, strengthening relationships, experiencing improved health, and ownership of decision), and appreciating medical responsiveness (attentive monitoring and communication, depending on learning and support, developing readiness, and clinician validation). Non-English articles were excluded. Patients and caregivers perceive that home HD offers the opportunity to thrive improves freedom, flexibility, and well-being and strengthens relationships. However, some voice anxiety and fear about starting home HD due to the confronting nature of the treatment and isolation from medical and social support. Acknowledging and addressing these apprehensions can improve the delivery of predialysis and home HD programs to better support patients and caregivers considering home HD.
Publisher: SAGE Publications
Date: 11-2016
Abstract: Being aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has undertaken a review of PD training programs around the world in order to develop a syllabus for PD training. This syllabus has been developed to help PD nurses train patients and caregivers based on a consensus of training program reviews, utilizing current theories and principles of adult education. It is designed as a 5-day program of about 3 hours per day, but both duration and content may be adjusted based on the learner. After completion of our proposed PD training syllabus, the PD nurse will have provided education to a patient and/or caregiver such that the patient/caregiver has the required knowledge, skills and abilities to perform PD at home safely and effectively. The course may also be modified to move some topics to additional training times in the early weeks after the initial sessions. Extra time may be needed to introduce other concepts, such as the renal diet or healthy lifestyle, or to arrange meetings with other healthcare professionals. The syllabus includes a checklist for PD patient assessment and another for PD training. Further research will be needed to evaluate the effect of training using this syllabus, based on patient and nurse satisfaction as well as on infection rates and longevity of PD as a treatment.
Publisher: Wiley
Date: 10-12-2015
DOI: 10.1111/JORC.12100
Abstract: For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Elsevier BV
Date: 11-2019
Publisher: Wiley
Date: 09-01-2022
DOI: 10.1111/NEP.14018
Abstract: People with chronic kidney disease (CKD) living in rural communities have increased risks of death, morbidity, hospitalization and poorer quality of life compared with people with CKD living in urban areas. This study explores the experiences and perceptions of rural and remote patients and families in relation to accessing health services for kidney disease in Aotearoa New Zealand. We conducted an In‐depth interview study. We purposively s led adult patients with CKD and their caregivers who lived further than 100 km (62 miles) or more than 1 h drive from their nearest dialysis or transplant centre. Qualitative data were analyzed inductively to generate themes, subthemes and a conceptual framework. Of 35 participants, including 26 patients and nine caregivers, 51% were female, 71% travelled between 1 and 3 h to their nearest renal unit, and the remainder, between 3 and 6 h. We identified five themes and related subthemes: intense psychological impact of rurality pressure of extended periods away from home services not designed for rural and remote living suffering from financial losses and poor communication. Rural and remote patients with CKD and their caregivers face the added challenges of separation from family, social and community support and financial burden, which can have profound consequences on their psychological and physical well‐being and that of their families.
Publisher: Wiley
Date: 15-05-2016
DOI: 10.1111/HDI.12424
Publisher: BMJ
Date: 15-04-2015
Publisher: Springer Science and Business Media LLC
Date: 20-09-2014
Publisher: Elsevier BV
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12939-019-1115-Y
Abstract: Kidney transplantation is considered best practice treatment for end stage kidney disease (ESKD), however Indigenous patients are substantially less likely to receive either a deceased or live donor kidney transplant than non-Indigenous patients. We describe Indigenous peoples’ experiences and perspectives including traditional values around kidney transplantation to inform international transplant programs. We conducted a systematic review of qualitative studies involving Indigenous adults who have experience with or perceptions of kidney transplantation. We searched MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies till July 2019. We utilised thematic synthesis to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. Eight studies involving 225 Indigenous participants were included. Five themes were identified: strong desire for transplantation (seeking normality and freedom from dialysis, wanting to reduce burden of disease within community) lack of partnership in shared decision-making (receiving inadequate information, ineffective communication) barriers to live kidney donation (difficulty asking, apprehension about impact on donor, avoiding additional financial burden and fear of complications) cultural considerations (influence of traditional values and beliefs, reconciling traditional values with pragmatic need) and experiencing lack of cultural competence in clinical care (struggling with prejudice and ignorance, mistrust of clinicians and health system). Indigenous participants had a strong desire for a kidney transplant and recognised the need for more readily available kidney transplants for others in their communities with ESKD. However, they faced prejudice and a lack of cultural competence by health workers as well as wider barriers to transplantation in systems that did not support effective and culturally appropriate delivery of information and care. Traditional cultural values also influenced decisions regarding kidney transplantation but such values were moderated when considering transplantation. Transplantation programs need to identify and mitigate barriers, such as the financial burden, promote cultural safety and incorporate traditional values into the promotion of transplantation in order to address inequitable transplantation rates. Not applicable.
Publisher: Elsevier BV
Date: 03-2020
Publisher: SAGE Publications
Date: 20-09-2022
DOI: 10.1177/08968608221126849
Abstract: Gastrointestinal (GI) health is considered vital to the success of peritoneal dialysis (PD) and is critically important to patients, caregivers and clinicians. However, the multiplicity of GI outcome measures in trials undermines the ability to evaluate the frequency, impact and treatment of GI symptoms in patients receiving PD. Therefore, this study aimed to assess the range and consistency of GI outcomes reported in contemporary PD trials. Systematic review. In iduals with kidney failure requiring PD. All randomised controlled trials involving patients on PD, identified from the PUBMED, EMBASE and COCHRANE Central Registry of controlled Trials (CENTRAL) database, from January 2010 to July 2022. Any PD-related intervention. The frequency and characteristics of GI outcome measures were analysed and classified. Of the 324 eligible PD trials, GI outcomes were only reported in 61 (19%) trials, mostly as patient-reported outcomes (45 trials 74%). The most frequently reported outcomes were nausea in 27 (43%), diarrhoea in 26 (43%), vomiting in 22 (36%), constipation in 21 (34%) and abdominal pain in 19 (31%) of trials. PD peritonitis was the primary non-GI outcome reported in 24 (40%) trials, followed by death in 13 (21%) trials) and exit-site infection in 9 (15%) trials). Across all trials, 172 GI outcome measures were extracted and grouped into 29 different outcomes. Nausea and diarrhoea contributed to 16% and 15% of GI outcomes, respectively, while vomiting, constipation and abdominal pain contributed to 13%, 12% and 12%, respectively. Most (90%) GI outcomes were patient-reported adverse effects with no defined metrics. Faecal microbiome was reported as the primary study outcome in 3 (100%) trials using the subjective global assessment score, GI symptom rating scale and faecal microbiological and biochemical analysis. Two trials reported nausea as a primary study outcome using symptom assessment score (SAS) and kidney disease quality of life-short-form-36. One trial each reported anorexia and abdominal pain as the primary study outcome using SAS. Bowel habits, constipation and stool type were also reported as the primary study outcome in one trial each using the Bristol stool form scale. GI bleeding was reported as the secondary outcome in three (37%) out of eight trials reporting it. Restricted s ling frame to focus on contemporary trials. Despite the clinical importance of GI outcomes among patients on PD, they are reported in only 19% of PD trials, using inconsistent metrics, often as patient-reported adverse events. Efforts to standardise GI outcome reporting are critical to optimising comparability, reliability and value of trial evidence to improve outcomes for patients receiving PD.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-10-2018
DOI: 10.2215/CJN.06830617
Abstract: Improved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities. We conducted a prospective, discrete choice experiment survey with random parameter logit analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis). The attributes included schedule flexibility, patient out of pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, wellbeing on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using β -coefficients with corresponding odds ratios and 95% confidence intervals for choosing home-based dialysis (peritoneal dialysis or hemodialysis) compared with facility hemodialysis. Home-based therapies were significantly preferred with the following attributes: longer survival (odds ratio per year, 1.63 95% confidence interval, 1.25 to 2.12), increased treatment flexibility (odds ratio, 9.22 95% confidence interval, 2.71 to 31.3), improved wellbeing (odds ratio, 210 95% confidence interval, 15 to 2489), and more nursing support (odds ratio, 87.3 95% confidence interval, 3.8 to 2014). Respondents were willing to accept additional out of pocket costs of approximately New Zealand $400 (United States $271) per month (95% confidence interval, New Zealand $333 to $465) to receive increased nursing support. Patients were willing to accept out of pocket costs of New Zealand $223 (United States $151) per month (95% confidence interval, New Zealand $195 to $251) for more treatment flexibility. Patients preferred home dialysis over facility-based care when increased nursing support was available and when longer survival, wellbeing, and flexibility were expected. Sociodemographics, such as age, ethnicity, and income, influenced patient choice.
No related grants have been discovered for Rachael Walker.