Andrea K Viecelli1,2, Martin Howell3,4, Allison Tong3,4, Armando Teixeira-Pinto3, Emma O'Lone3,4, Angela Ju3,4, Jonathan C Craig5, Lai-Seong Hooi6, Timmy Lee7,8, Charmaine E Lok9,10, Kevan R Polkinghorne11,12,13, Robert R Quinn14, Tushar J Vachharajani15, Raymond Vanholder16,17, Li Zuo18, Jan Tordoir19, Roberto Pecoits-Filho20, Theodore Yuo21, Pascal Kopperschmidt22, Rob Smith23, Ashley B Irish24,25, Trevor A Mori25, Elaine M Pascoe2, David W Johnson1,2,26, Carmel M Hawley1,2,26. 1. Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia. 2. Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia. 3. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 4. Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia. 5. College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia. 6. Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia. 7. Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA. 8. Section of Nephrology, Veterans Affairs Medical Center, Birmingham, AL, USA. 9. Division of Nephrology, University Health Network, Toronto, ON, Canada. 10. Department of Medicine, University of Toronto, Toronto, ON, Canada. 11. Department of Nephrology, Monash Medical Centre, Melbourne, VC, Australia. 12. Department of Medicine, Monash University, Melbourne, VC, Australia. 13. School of Public Health and Preventive Medicine, Monash University, Melbourne, VC, Australia. 14. Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, AB, Canada. 15. Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 16. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. 17. Department of Nephrology, Ghent University Hospital, Ghent, Belgium. 18. Department of Nephrology, Peking University People's Hospital, Beijing, China. 19. Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. 20. School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. 21. Department of Surgery, Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 22. Fresenius Medical Care, Global Research & Development, Schweinfurt, Germany. 23. Nightcliff Renal Unit, Darwin, NT, Australia. 24. Department of Nephrology, Fiona Stanley Hospital, Perth, WA, Australia. 25. Medical School, University of Western Australia, Perth, WA, Australia. 26. Translational Research Institute, Brisbane, QLD, Australia.
Abstract
BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
Authors: Yong Pey See; Yeoungjee Cho; Elaine M Pascoe; Alan Cass; Ashley Irish; David Voss; Kevan R Polkinghorne; Lai Seong Hooi; Loke-Meng Ong; Peta-Anne Paul-Brent; Peter G Kerr; Trevor A Mori; Carmel M Hawley; David W Johnson; Andrea K Viecelli Journal: Kidney360 Date: 2020-09-14
Authors: Erica Musgrove; Loretta Gasparini; Katie McBain; Susan A Clifford; Simon A Carter; Helena Teede; Melissa Wake Journal: Pediatr Res Date: 2021-12-17 Impact factor: 3.953