Dedication of a nurse to educating suboptimal haemodialysis starts improved transition to independent modalities of renal replacement therapy

Hanko, Jennifer; Jastrzebski, Jacek; Nieva, Cheryl; White, Leigh Ann; Li, Guiyun; Zalunardo, Nadia

doi:10.1093/ndt/gfq669

Cited by 31 publications

(56 citation statements)

References 29 publications

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“…The perception of minimal impact may also relate to the absence of a formal training program to teach dialysis nurses how to educate patients. Although nephrology nurses can be effective at guiding modality selection [30-32], traditionally, the role of dialysis nurses has not primarily been patient education.…”

Section: Discussionmentioning

confidence: 99%

Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study

et al. 2013

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BackgroundThere is a paucity of information about the views of dialysis nurses towards dialysis modality selection, yet nurses often have the most direct contact time with patients. We conducted a survey to better understand nurses’ attitudes and perceptions, and hypothesized that nurses with different areas of expertise would have differences in opinions.MethodsWe administered an electronic survey to all dialysis/predialysis nurses (n = 129) at a large, tertiary care center. The survey included questions about preferred therapy - in-center hemodialysis (CHD), versus home dialysis (home hemodialysis and peritoneal dialysis) and ideal modality mix. Responses were compared between nurses with home dialysis and CHD experience.ResultsThe survey response rate was 69%. Both nursing groups ranked patient caregivers and dialysis nurses as having the least impact on patient modality selection. For most patient characteristics (including age > 70 years and presence of multiple chronic illnesses), CHD nurses felt that CHD was somewhat or strongly preferred, while home dialysis nurses preferred a home modality (p < 0.001 for all characteristics studied). Similar differences in responses were noted for patient/system factors such as patient survival, cost to patients and nursing job security. Compared to CHD nurses, a higher proportion of home dialysis nurses felt that CHD was over-utilized (85% versus 58%, p = 0.024).ConclusionDialysis nurses have prevailing views about modality selection that are strongly determined by their area of experience and expertise.

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Section: Discussionmentioning

confidence: 99%

Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study

et al. 2013

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“…One recent study evaluated the effect of an in-hospital education programme among 228 patients requiring acute dialysis starts [9]. Our study shows that a sub-optimal dialysis initiation defined by a short stay on HD before starting PD was associated neither with an increased risk of death nor with a decreased probability of renal transplantation.…”

Section: Discussionmentioning

confidence: 74%

“…Furthermore, it has recently been shown in a single-centre retrospective study that acute starters have a similar outcome on PD and on HD [7]. Efforts are currently made to offer a free choice of the dialysis modality to the unplanned dialysis starter [8,9]. These considerations may increase the number of patients starting PD after a short stay on HD in coming years.…”

Section: Introductionmentioning

confidence: 99%

Outcome of the sub-optimal dialysis starter on peritoneal dialysis. Report from the French Language Peritoneal Dialysis Registry (RDPLF)

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et al. 2013

Nephrology Dialysis Transplantation

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A B S T R AC TBackground. This study was carried out to examine the association of sub-optimal dialysis initiation of peritoneal dialysis (PD) with all the possible outcomes on PD using survival analysis in the presence of competing risks. Methods. This was a retrospective cohort study based on the data of the French Language Peritoneal Dialysis Registry. We analysed 8527 incident patients starting PD between January 2002 and December 2010. The end of the observation period was 01 June 2011. Times from the start of PD to death, transplantation, transfer to haemodialysis (HD) and first peritonitis episode were calculated. The sub-optimal dialysis initiation was defined by a period of <30 days on HD before PD initiation. Results. Among 8527 patients, there were 568 patients who started PD after <30 days on HD. There were 6562 events: 3078 deaths, 2136 transfers to HD, 1348 renal transplantations. When using a Fine and Gray model, sub-optimal dialysis start, early peritonitis and transplant failure were associated with a higher sub-distribution relative hazard of technique failure. There was no association between the suboptimal dialysis start and the sub-distribution hazard of death or transplantation. In the multivariate analysis using a Fine and Gray regression model, the sub-optimal dialysis start was not associated with a higher sub distribution relative hazard of peritonitis. Conclusions. Sub-optimal dialysis initiation is neither associated with a higher risk of death nor with a lower risk of renal transplantation. Sub-optimal PD patients had a higher risk of transfer to HD.

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“…The initiation of dialysis is unplanned in up to 50% of patients, and these patients typically default to in‐centre HD and are unlikely to change modalities . While patients with suboptimal HD starts are likely to incur delays to their transition to home HD, because of vascular access problems, we found that these participants also experienced immediate lifestyle benefits from home HD. To some extent, our findings support the aims of ‘home first’ initiatives, to encourage patients immediately to home HD .…”

Section: Discussionmentioning

confidence: 75%

Patient experiences of training and transition to home haemodialysis: A mixed‐methods study

et al. 2017

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Dedication of a nurse to educating suboptimal haemodialysis starts improved transition to independent modalities of renal replacement therapy

Abstract: Addition of the RTN to the HD care team facilitated transition to independent modalities of RRT in suboptimal HD starts. This standardized approach to the care of such patients should be considered in HD units where suboptimal HD starts are common.

Cited by 31 publications

References 29 publications

Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study

Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study

Outcome of the sub-optimal dialysis starter on peritoneal dialysis. Report from the French Language Peritoneal Dialysis Registry (RDPLF)

Patient experiences of training and transition to home haemodialysis: A mixed‐methods study

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