Dialysis Modality Preference of Patients With CKD and Family Caregivers: A Discrete-Choice Study

Morton, Rachael L.; Snelling, Paul; Webster, Angela C; Rose, John M.; Masterson, Rosemary; Johnson, David W.; Howard, Kirsten

doi:10.1053/j.ajkd.2011.12.030

Cited by 103 publications

(92 citation statements)

References 27 publications

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“…While purely speculative, we question whether caregivers, under certain circumstances where they have experienced a gradual increase in the amount of care-giving required or feel overly burdened by the care needs, may advocate against patients returning to PD after, for example, a peritonitis requiring catheter removal or an acute illness requiring temporary cessation of PD. Data from ongoing studies, such as PD outcomes and practice patterns study may help answer some of these questions, in particular whether the observed gradual increase in the number of patients with functional disability who now are managed using chronic PD, correlate with a gradual increase in PD technique failure rates, such as that seen over the last decade (21,(41)(42)(43)(44)(45).…”

Section: Discussionmentioning

confidence: 99%

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

et al. 2016

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♦ Background: Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL). ♦ Methods: We used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE).♦ Results: A total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL. ♦ Conclusions: Impaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.

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Section: Discussionmentioning

confidence: 99%

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

et al. 2016

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“…Of patients assessed, the proportion that are declared eligible for PD will vary widely (7,8,(12)(13)(14). Key factors will include the age and overall comorbidity burden of the population being accepted for dialysis.…”

Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

“…The element of experience and confidence may also be such that, compared with newer PD programs, more established PD programs might be more "aggressive" about offering PD to "marginal" patients. When centers are compared, the estimated proportion of patients eligible to do PD is highly variable, typically running between 40% and 80%-thus being a major determinant of a program's ultimate PD utilization percentage (7,8,(12)(13)(14). The whole topic of perceived eligibility and ineligibility to do PD is an area that needs extensive research, and we think that application of the process we are suggesting would be helpful in highlighting inappropriate differences between PD programs.…”

Section: Step 2: Assessment For Pd Eligibilitymentioning

confidence: 99%

Peritoneal Dialysis and the Process of Modality Selection

2012

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The process of modality selection and how it works is a critical determinant of peritoneal dialysis (PD) utilization. This very complex process has not been well analyzed. Here, we break it down into 6 steps and point out how problems at each step can significantly reduce the proportion of endstage renal disease patients initiating PD. It is important that any program wising it to grow its use of PD understand the steps and the points at which problems may be arising. Examples are presented. Perit Dial Int

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“…Data suggest that patients often have preferences for how they live and the kinds of treatments that they are willing to undergo for a given goal (19)(20)(21). By learning the specific preferences and goals of a given patient, the clinician has a better idea of which treatment path may be most appropriate for that individual.…”

Section: Consideration Of Treatment Paths For Patients Who May Do Poorlymentioning

confidence: 99%

A Communication Framework for Dialysis Decision-Making for Frail Elderly Patients

Schell

Cohen

2014

Clinical Journal of the American Society of Nephrology

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Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented. The role of uncertainty is highlighted, and the concept of a goaldirected care plan is introduced. This plan incorporates a time-limited trial that promotes frequent opportunities for reassessment. Using the communication skills presented, the clinician can prepare and guide patients for the dialysis trajectory as it unfolds.

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Dialysis Modality Preference of Patients With CKD and Family Caregivers: A Discrete-Choice Study

Cited by 103 publications

References 27 publications

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

Peritoneal Dialysis and the Process of Modality Selection

A Communication Framework for Dialysis Decision-Making for Frail Elderly Patients

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