Setting Research Priorities for Patients on or Nearing Dialysis

Manns, Braden; Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P.G.; Cyr, Annette; Gladish, Michael; Large, Claire L.; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

doi:10.2215/cjn.01610214

Cited by 270 publications

(273 citation statements)

References 11 publications

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“…It is associated with substantially reduced quality of life, depression, poor sleep quality, and increased mortality (2) (Supplemental Movie 1) but has been underrecognized by health care providers (3)(4)(5). Research into pruritus is a high priority for patients (6).…”

Section: Introductionmentioning

confidence: 99%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

190

238

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Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012-2015 were analyzed to describe predictors, effects, medical directors' awareness, and treatment of pruritus.Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012-2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan.Conclusions The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus.

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Section: Introductionmentioning

confidence: 99%

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

Rayner¹,

Larkina²,

Mia³

et al. 2017

CJASN

190

238

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“…The association between QoL, mortality, and hospitalization has been shown in ESRD (2)(3)(4), and reducing the physical, social, and psychologic effects of kidney disease is a top research priority for people with ESRD (5).…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study to Explore Patient and Staff Perceptions of Intradialytic Exercise

Thompson

Klarenbach

Molzahn

2016

CJASN

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Background and objectives Randomized, controlled trials show that regular exercise is beneficial for patients on hemodialysis. Intradialytic exercise may have additional benefits, such as amelioration of treatment-related symptoms. However, the factors that influence the implementation of intradialytic exercise are largely unknown.Design, setting, participants, & measurements Individual semistructured interviews were conducted with a purposive sample of patients on hemodialysis who had participated in a pilot randomized, controlled trial on intradialytic exercise and dialysis staff that worked in the unit during the trial. The trial took place from July to December of 2014 and enrolled 31 patients. Interviews were conducted from April to December of 2014. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group codes into common themes, first individually and then, across staff and patient interviews.Results Twenty-five patients and 11 staff were interviewed. Three themes common to both groups emerged: support, norms (expected practices) within the dialysis unit, and the role of the dialysis nurse. The support of the kinesiologist enhanced patients' confidence and sense of capability and was a key component of implementation. However, the practice of initiating exercise at the start of the shift was a barrier to staff participation. Staff focused on the technical aspects of their role in intradialytic exercise, whereas patients viewed encouragement and assistance with intradialytic exercise as the staff's role. An additional theme of no time (for staff to participate in intradialytic exercise) was influenced by its low priority in their workflow and the demands of the unit. The staff's emphasis on patients setting up their own equipment and enhanced social interaction among participants were additional themes that conveyed the unintended consequences of the intervention. ConclusionsThe kinesiologist-patient interactions and staff readiness for intradialytic exercise were important factors in the implementation of intradialytic exercise. Understanding how unit workflow and the personal values of staff can influence implementation may improve the design of intradialytic exercise interventions.

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“…The group acknowledged the high prevalence of this symptom [21] and its importance to patients [22], but deemed it more appropriate to explore the applicability of existing non-renal guidelines [23], or develop pruritus management guidelines targeting CKD stage 3b-5 patients in general.…”

Section: Discussionmentioning

confidence: 99%

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

et al. 2016

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2 Abstract PurposeTo identify and prioritize potential topics to be addressed in the development of European, multidisciplinary guidelines on the management of chronic kidney disease stage 3b to 5 in older patients. MethodsWe composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-toface consensus meeting, following a Nominal Group Technique structure with two voting rounds. Topics were rated on a 9-point scale ranging from 1 ('not at all important') to 9('critically important'). ResultsThe highest rating (median; range) was assigned to 'Screening and referral' (8.5; 2.0). Eight topics shared the second highest rating with a median priority score of 8.0 (2.0), and included 'Starting dialysis or not' and 'Accurate assessment of renal function'.

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Setting Research Priorities for Patients on or Nearing Dialysis

Cited by 270 publications

References 11 publications

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

A Qualitative Study to Explore Patient and Staff Perceptions of Intradialytic Exercise

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

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