Patients' Experiences and Perspectives of Living With CKD

Tong, Allison; Sainsbury, Peter; Chadban, Steven J.; Walker, Rowan G.; Harris, David C.H.; Carter, Stacy M; Hall, Bronwyn; Hawley, Carmel M.; Craig, Jonathan C.

doi:10.1053/j.ajkd.2008.10.050

Cited by 184 publications

(258 citation statements)

References 18 publications

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“…There were no clear differences between included age ranges, geographic area, or time of publication. The results of this synthesis share similarities with two previous studies reporting the experiences of patients living with CKD and peritoneal dialysis (13,58). Both studies also emphasized the importance of acceptance and adaptation to gaining control (13,58).…”

Section: Discussionsupporting

confidence: 84%

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Reid

Seymour

Jones

2016

CJASN

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Background and objectives Patients on in-center dialysis spend significant amounts of time in the dialysis unit; additionally, managing ESRD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis, their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesize the experiences of patients receiving in-center hemodialysis.Design, setting, participants, & measurements We searched Embase, MEDLINE, CINAHL, PsychINFO, Google Scholar, and reference lists for primary qualitative studies published from 1995 to 2015 that explored the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted.Results Seventeen studies involving 576 patients were included in the synthesis. Four analytic themes were developed. The first theme (a new dialysis-dependent self) describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme (a restricted life) describes the physical and emotional constraints that patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future, and these contributed to the third theme (regaining control). The first three themes describe a potential for change through acceptance, adaption, and regaining a sense of control. The final theme (relationships with health professionals) describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity, and personalized support.Conclusions Our synthesis has resulted in a framework that can be used to consider interventions to improve patients' experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships that patients have with their health care professionals may enable patients to progress toward a sense of control and improve satisfaction with care.

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Section: Discussionsupporting

confidence: 84%

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Reid

Seymour

Jones

2016

CJASN

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“…These associations generally persisted after adjustment for baseline satisfaction and HRQOL, showing that the association of social support with these measures continues over time. In light of these results and because patients believe lack of psychosocial support to be a top priority for both clinical care and research in chronic kidney disease (21,22), interventions to increase support could potentially provide dramatic benefits for satisfaction and HRQOL among those with ESRD. Among the clinical outcomes examined, lower hospitalization rates were associated with highest versus lowest levels of social support (15% reduction associated with greater overall social support).…”

Section: Discussionmentioning

confidence: 99%

Association of Social Support with Outcomes in Incident Dialysis Patients

Plantinga

Fink

Harrington-Levey

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: The association of social support with outcomes in ESRD, overall and by peritoneal dialysis (PD) versus hemodialysis (HD), remains understudied.Design, setting, participants, & measurements: In an incident cohort of 949 dialysis patients from 77 US clinics, we examined functional social support scores (scaled 0 to 100 and categorized by tertile) both overall and in emotional, tangible, affectionate, and social interaction subdomains. Outcomes included 1-year patient satisfaction and quality of life (QOL), dialysis modality switching, and hospitalizations and mortality (through December 2004). Associations were examined using overall and modality-stratified multivariable logistic, Poisson, and Cox proportional hazards models.Results: We found that mean social support scores in this population were higher in PD versus HD patients (overall 80.5 versus 76.1; P < 0.01). After adjustment, highest versus lowest overall support predicted greater 1-year satisfaction and QOL in all patients (odds ratio 2.47 [95% confidence interval (CI) 1.18 to 5.15] and 2.06 [95% CI 1.31 to 3.22] for recommendation of center and higher mental component summary score, respectively). In addition, patients were less likely to be hospitalized (incidence rate ratio 0.86; 95% CI 0.77 to 0.98). Results were similar with subdomain scores. Modality switching and mortality did not differ by social support in these patients, and associations of social support with outcomes did not generally differ by dialysis modality.Conclusions: Social support is important for both HD and PD patients in terms of greater satisfaction and QOL and fewer hospitalizations. Intervention studies to possibly improve these outcomes are warranted.

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“…Dialysis patients have a high morbidity and mortality. Patients' experience of living with dialysis is significantly affected by many factors including physical symptoms, substantial comorbidity -particularly cardiovascular, complex dialysis regimens, high pill burdens and the need for dietary and fluid restrictions [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Sertraline Versus Placebo in Patients with Major Depressive Disorder Undergoing Hemodialysis: A Randomized, Controlled Feasibility Trial

Friedli¹,

Guirguis²,

Almond³

et al. 2017

CJASN

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Background and objectives Depression is common in patients on hemodialysis, but data on the benefits and risks of antidepressants in this setting are limited. We conducted a multicenter, randomized, double-blind, placebo-controlled trial of sertraline over 6 months in patients on hemodialysis with depression to determine study feasibility, safety, and effectiveness. Design, setting, participants, & measurements Patients on hemodialysis at five United Kingdom renal centers completed the Beck Depression Inventory II. Those scoring ≥16 and not already on treatment for depression were invited to undergo diagnostic interview to confirm major depressive disorder. Eligible patients with major depressive disorder were randomized to receive the study medication—either sertraline or placebo. Outcomes included recruitment and dropout rates, change in the Montgomery–Asberg Depression Rating Scale and Beck Depression Inventory II, and qualitative information to guide design of a large-scale trial. Results In total, 709 patients were screened and enrolled between April of 2013 and October of 2014; 231 (32.6%) had Beck Depression Inventory II scores ≥16, and 68 (29%) of these were already receiving treatment for depression. Sixty-three underwent diagnostic interview, 37 were diagnosed with major depressive disorder, and 30 were randomized; 21 completed the trial: eight of 15 on sertraline and 13 of 15 on placebo (P=0.05). Dropouts due to adverse and serious adverse events were greater in the sertraline group. All occurred in the first 3 months. Over 6 months, depression scores improved in both groups. Beck Depression Inventory II score fell from 29.1±8.4 to 17.3±12.4 (P<0.001), and Montgomery–Asberg Depression Rating Scale score fell from 24.5±4.1 to 10.3±5.8 (P<0.001). There were no differences between sertraline and placebo groups. Conclusions Although small, this is the largest randomized trial to date of antidepressant medication in patients on hemodialysis. Our results highlight recruitment issues. No benefit was observed, but trial size and the substantial dropout render consideration of benefit inconclusive. A definitive trial could use shorter follow-up and include depressed patients already taking antidepressants.

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Patients' Experiences and Perspectives of Living With CKD

Cited by 184 publications

References 18 publications

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Association of Social Support with Outcomes in Incident Dialysis Patients

Sertraline Versus Placebo in Patients with Major Depressive Disorder Undergoing Hemodialysis: A Randomized, Controlled Feasibility Trial

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