Dialysis Modality Choice and Initiation: Global Preferences

Sethi, Sidharth Kumar; Xu, Hong; McCulloch, Mignon; Nourse, Peter; Bagga, Arvind; Geary, Denis F.

doi:10.1007/978-3-662-52972-0_62

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…In many rural areas, especially in lower income countries, there are no options or extremely limited options for kidney replacement therapy (transplant or dialysis) due to availability of resources [ 54 , 55 ]. Pediatric CKD patients may receive adult dialysis or no kidney replacement therapy at all, and children on dialysis in rural and semi-rural areas are about 25% less likely to be seen by a pediatric nephrologist [ 56 ].…”

Section: Rurality Confers Barriers To Kidney Replacement Therapy Optionsmentioning

confidence: 99%

The impact of rural status on pediatric chronic kidney disease

Weidemann

Harshman

2023

Pediatr Nephrol

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Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

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Section: Rurality Confers Barriers To Kidney Replacement Therapy Optionsmentioning

confidence: 99%

The impact of rural status on pediatric chronic kidney disease

Weidemann

Harshman

2023

Pediatr Nephrol

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Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review

Jia

Tang

et al. 2023

BMC Nephrol

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Background The exact optimal timing of dialysis for ESKD patients remains unknown. This study systematically reviewed the available evidence with regard to the optimal initiation of maintenance dialysis in ESKD patients. Methods An electronic search was performed in Embase, PubMed and the Cochrane Library in order to find studies investigating associations between variables reference to “start of dialysis” and outcomes. Quality assessment and bias assessment were performed by the Newcastle–Ottawa scale and the ROBINSI tool. Due to the heterogeneity of studies, a meta-analysis could not be performed. Results Thirteen studies were included; four studies included only haemodialysis patients, three peritoneal dialysis, six both; study outcomes included mortality, cardiovascular events, technique failure, quality of life and others. Nine studies mainly focused on the optimal GFR of maintenance dialysis initiation; five studies showed none association between GFR and mortality or other adverse outcomes, two studies showed dialysis initiation at higher GFR levels were with poor prognosis, and 2 studies showed higher GFR levels with better prognosis. Three studies paid attention to comprehensive assessment of uremic signs and/or symptoms for optimal dialysis initiation; uremic burden based on 7 uremic indicators (hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate) were not associated with mortality; another equation (combination of sex, age, serum creatinine, blood urea nitrogen, serum albumin, haemoglobin, serum phosphorus, diabetes mellitus, and heart failure) based on fuzzy mathematics to assess the timing of haemodialysis initiation was accuracy to prognose 3-year survival; the third study found that volume overload or hypertension was associated with the highest risk for subsequent mortality. Two studies compared urgent or optimal start in dialysis, a study reported increased survival in optimal start patients, another reported no differences between Urgent-Start-PD and Early-Start-PD regarding 6-month outcomes. Limitations: Heterogeneity among the studies was quite high, with differences in sample size, variable and group characteristics; no RCT studies were included, which weakened the strength of evidences. Conclusions The criteria for dialysis initiation were varied. Most studies proved that GFR at dialysis initiation was not associated with mortality, timing of dialysis initiation should not be based on GFR, assessments of volume load and patient’s tolerance to volume overload are prospective approaches.

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Dialysis Modality Choice and Initiation: Global Preferences

Cited by 2 publications

References 38 publications

The impact of rural status on pediatric chronic kidney disease

The impact of rural status on pediatric chronic kidney disease

Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review

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