Transplantability In Burdened Populations: A Regional Analysis of the Robotic-Assisted Kidney Transplant Impact On Access Given Socioeconomic And Demographic Factors

Introduction/Background The social contract of health (SCOH) in America that governs healthcare interactions has listed toward provider organizations and away from the patient. End stage renal disease treatment provides an explicatory case to examine an unbalanced SCOH. The study evaluates whether the robot-assisted kidney transplantation (RAKT) technique allows for patients with higher body mass indices and of burdened socioeconomic and sociodemographic status improved access to transplant compared to traditional open kidney transplant (OKT). Methods The study set combined extant data for patients transplanted at Chicago from two data sets. Investigators used independent t-tests, chi-squared tests, survival analysis, analysis of frequencies, and bivariate correlation to ascertain differences in the RAKT and OKT cohorts from January 1, 2009, to December 31, 2018. Results The RAKT group was objectively sicker, demonstrated higher proportions of recipients with Black ethnicity, without a college degree, and lower median household income. The RAKT cohort had a markedly lower wait time for kidney transplant (499.5 days vs 822.7 days in OKT). Patients with BMI over 40 in the two groups had no statistically significant difference in length of stay, graft function, or post-transplant outcomes. Conclusions/Implications Despite the myriad of disadvantages, the RAKT cohort clinical outcomes were equivalent to OKT in most respects and superior in wait list duration. As rates of obesity and kidney disease increase, wider proliferation of tools with demonstrated efficacy in treating this population support the social contract of health. Community psychology praxis can support communities in advocating for change in the American healthcare system

Data quality and patient characteristics in European ANCA-associated vasculitis registries: data retrieval by federated querying

Objectives This study aims to describe the data structure and harmonisation process, explore data quality and define characteristics, treatment, and outcomes of patients across six federated antineutrophil cytoplasmic antibody-associated vasculitis (AAV) registries.Methods Through creation of the vasculitis-specific Findable, Accessible, Interoperable, Reusable, VASCulitis ontology, we harmonised the registries and enabled semantic interoperability. We assessed data quality across the domains of uniqueness, consistency, completeness and correctness. Aggregated data were retrieved using the semantic query language SPARQL Protocol and Resource Description Framework Query Language (SPARQL) and outcome rates were assessed through random effects meta-analysis.Results A total of 5282 cases of AAV were identified. Uniqueness and data-type consistency were 100% across all assessed variables. Completeness and correctness varied from 49%–100% to 60%–100%, respectively. There were 2754 (52.1%) cases classified as granulomatosis with polyangiitis (GPA), 1580 (29.9%) as microscopic polyangiitis and 937 (17.7%) as eosinophilic GPA. The pattern of organ involvement included: lung in 3281 (65.1%), ear-nose-throat in 2860 (56.7%) and kidney in 2534 (50.2%). Intravenous cyclophosphamide was used as remission induction therapy in 982 (50.7%), rituximab in 505 (17.7%) and pulsed intravenous glucocorticoid use was highly variable (11%–91%). Overall mortality and incidence rates of end-stage kidney disease were 28.8 (95% CI 19.7 to 42.2) and 24.8 (95% CI 19.7 to 31.1) per 1000 patient-years, respectively.Conclusions In the largest reported AAV cohort-study, we federated patient registries using semantic web technologies and highlighted concerns about data quality. The comparison of patient characteristics, treatment and outcomes was hampered by heterogeneous recruitment settings

An exploration into nephrology nurses' lived experiences of caring for dying patients with end stage kidney disease following withdrawal of dialysis

The aim of this study sets out to better understand nephrology nurses’ lived experiences of dying and deaths of patients with ESKD following withdrawal of dialysis. A qualitative research design using an interpretative phenomenological approach was used to explore the experiences of a purposive heterogeneous sample of eight nephrology nurses who were working in private dialysis units. Information was gathered by phenomenological conversations and feed-back sessions. Colaizzi’s phenomenological method was employed to formulate four main themes: 1. Emotional trauma 2. Detachment 3. Loss of altruistic values in nursing 4. being-with-death For the participants in this study, emotional trauma was the most significant. The participants experienced a sense of powerlessness which caused emotions of hopelessness and anger and subsequently a sense of premature mourning and detachment. This state of hopelessness proved to be an obstacle in patient care, resulting in the altruistic values of nursing to be no longer applied. The participants’ ontological confrontation of being-with-death was evident, as they came to terms with the reality of their own death. Recommendations are offered to address the educational aspects of death and dying for nephrology nurses. This study endorses the need for further research into patients with ESKD ‘end-of-life’ which can influence how healthcare professionals should treat these patients during this phase

Young adults’ experiences of dialysis and kidney transplant decision-making.

Background Young adults with end-stage kidney disease make decisions to select a renal replacement therapy choice with the support of healthcare professionals once their kidneys fail. However, little is known about how they experience dialysis and kidney transplant decision-making and the effects on their well-being. Aim The aim was to explore how young adults who are diagnosed with end-stage kidney disease experience dialysis and/or kidney transplant decision-making, understand the meaning of their lived experiences, and investigate the effects of decision-making andchoice on their well-being. Methodology Interpretive phenomenology, informed by Heidegger’s hermeneutic principles, was used to purposefully recruit young adults with end-stage kidney disease through social media. A qualitative design using semi-structured interviews were conducted and the data analysed using Braun and Clarke’s thematic analysis approach. Findings Eighteen participants aged 18-30 years old were interviewed. Five themes developed from the analysis include: (1) world turned upside down; (2) experience of information delivery about options; (3) the experience of making my voice heard; (4) experiencing the new normal; and (5) the impact of decision-making and choice on well-being. Conclusion and original contribution This study illuminates our understanding of how young adults experience kidney therapy decision-making and their unmet informational and decisional needs. The majority struggle to cope due to the lack of support during the decision-making process. Kidney therapy decision-making and experiencing choice about therapies affect young adults’whole world and significantly impact their physical, psychosocial, and mental well-being.This thesis proposes a four-talk model, adding a new phase (‘implement talk’) to the existing phases (team talk, option talk, decision talk), to address some of the young adults’ unmet decisional needs and better support their well-being during the decision-making process

Medication adherence following kidney transplantation: a grounded theory study of transplant recipients' perspectives

Background: Medication adherence has shown to be problematic for many renal transplant recipients. While factors promoting or inhibiting medication adherence have been extensively researched, little is known about the processes leading to this behaviour as perceived by kidney transplant recipients. Also, no research on the perspectives of German kidney transplant recipients has yet been carried out. Research Question: The question underpinning this research was: “How do German renal transplant recipients perceive the processes leading to medication adherence or non-adherence?” Methods: Following informed consent, telephone interviews with 17 German renal transplant recipients were conducted, transcribed verbatim, and analysed according to the tenets of constructive Grounded Theory, until theoretical saturation was reached. The research has been approved by the research ethics committees of the School of Healthcare Sciences and the German Society of Nursing Science. Results: This research established the theory of medication-taking as a symbol of living with a chronic condition. This theory is underpinned by two categories: in the category reflecting on one’s own position, the participants discussed their role regarding the intake of medication, which was perceived very ambivalently and as just one component of self-management following transplantation. In the category experiencing facilitators and challenges, participants reported factors supporting or impeding medication-taking. Crucially, these are perceived very individually: what one finds helpful or challenging may be perceived in a fundamentally different way by someone else. Conclusions: This research has similar findings to other research in this field, such as the fact that renal transplantation is not a cure for a chronic condition. However, in contrast to other research, it has found a strong connection between medication-taking and participants’ self-reflection of being chronically ill. In this regard, it has emphasised the need for individualised care, preferably in the form of a team approach that includes patients and families as well as the different healthcare professions

Oman’s treated chronic kidney failure population in years 1980 to 2015: an epidemiology research

Background and aim: Epidemiological studies on incidence, prevalence, and other epidemiological variables of Oman’s treated kidney failure population have been limited, and questionable as to their use of rigorous research methods. The main aim of this study was to identify the epidemiological variables of treated patients with advanced kidney disease in Oman, the status of publishing on the studied population, and describing the dialysis sub-population characteristics in the northern region of Oman. Methods: First, a secondary data analysis was performed using data from the Oman's renal replacement therapy (RRT) register (1980-2015). The studied epidemiological variables included: incidence, prevalence, death figures, causes of death and treatment costs of the Oman’s treated kidney failure population, especially dialysis sub-population. The publications on chronic kidney failure population of Oman were explored at this stage. Secondly, a multi-centre, cross-sectional study (i.e. survey research) was conducted covering the dialysis sub-population of the northern region of Oman. The basic aim of the survey was to assist in developing the first description of the main characteristics (e.g. demography, primary diagnoses, and co-morbidities) of dialysis-treated patients with advanced kidney disease living the northern region of Oman. A convenience sample (n = 341) of participants were recruited from four renal dialysis centres (RDCs). Those who met the pre-specified study inclusion criteria were surveyed using a researcher-administered survey during October and November 2014. SomeFrom December 2014 to December 2015, there were some additional data was gathered (e.g. death figures) from December 2014 to December 2015. Results: The first RRT care that started in Oman was peritoneal dialysis (PD) in April 1980, while the well-structured PD programme started in 1992 and was boosted in 2007. In 1983, the first dialysis center was opened with seven machines for haemodialysis, serving 35 patients. By the end of 2015, the Ministry of Health (MOH) had 18 RDCs serving 1,439 patients on dialysis per annum for Oman’s population. The analysis of the RRT register's data showed that the mean prevalence for all years (1983-2015) was 724.9 dialysis patients per year. The mean incidence for the same years was 203.7 kidney failure patients per year. The mean death rate calculated for all years (1983-2015) was 58 deaths per year. The recorded causes of death were cardiovascular diseases, and infection. Over the years, it was described that death due to infections and cardiovascular diseases were increasing among the RRT population and particularly within dialysis cohort. The cost of the dialysis sessions increased dramatically from 2,246,627 OMR (~ 4.5 million GBP) in 1998 to 9,543,572 OMR (~20 million GBP) in 2015, which is a 325% increase. Among the databases searched, there were 44 articles, which either focused on, or mentioned Oman’s chronic kidney failure population. Most of these articles focused on kidney transplantation and were of limited and questionable methodologies. In the multi-centre cross-sectional study, the northern region of Oman was divided into two subdivisions. The average age of this population was 51.7 ± 15.8 (mean ± SD) with no statistical evidence of difference between the subdivisions of the northern region of Oman (P = 0.177). There were more males (n = 187 = 54.8%) than females (n = 154 = 45.2%), with no significant difference between subdivisions (P = 0.598). It was described that the divorce frequency was low in this population (n = 22 = 6.4%), with no significant difference between subdivisions (P = 0.49), but unemployment was high (n = 292 = 85.9%), showing no significant difference between subdivisions (P = 0.537). Nearly half of this population were illiterate (n = 164 = 48.1%), with more illiterate females (n = 103= 66.9%) compared to males (n = 61= 32.6%), and no significant difference between subdivisions (P = 0.174). Nearly half of the participants had been on dialysis for five years at the time of data collection (n = 165 = 48.4%). The most common co-morbidities reported by these participants were hypertension and diabetes combined (n = 156 = 32.4%). The main reported causes of death shown by the data gathered were cardiovascular diseases (n = 41 = 41.5%) and infection (n = 10 = 10.2%). More than half of the participants were hoping to have kidney transplantations as soon as possible (n = 173 = 50.7%). Conclusion: This study is a comprehensive description of the Oman’s RRT epidemiology. The data showed a significant increase in the incidence and prevalence of treated chronic kidney failure in Oman. It showed the increase in the cost of dialysis in Oman for the past 17 years (1998-2015), which is in line with the recent publications from Oman (Al-Alawi et al., 2017; Al-Ismaili et al., 2016) and is in line with global findings. This research’s results have contributed to providing a deeper understanding of the Oman’s treated chronic kidney failure population. It appears that there is a heavy burden borne by the country, the health sector and the patients on dialysis because of the complex nature of life-long treatment. Oman’s publications on this health problem were limited. Therefore, it is necessary to conduct additional research with rigorous methods to obtain a complete picture of this health problem in Oman