Setting Priorities for Optimizing Vascular Access Decision Making--An International Survey of Patients and Clinicians.

Many decisions around vascular access for haemodialysis warrant a collaborative treatment decision-making process, involving both clinician and patient. Yet, patients' experiences in this regard have been suboptimal. Although clinical practice guidelines could facilitate collaborative decision making, they often focus on the clinicians' side of the process, while failing to address the patients' perspective. The objective of this study was to explore and compare kidney patients' and clinicians' views on what vascular access-related decisions deserved priority for developing guidelines that will contribute to optimizing collaborative decision making.In the context of updating their vascular access guideline, European Renal Best Practice surveyed an international panel of 85 kidney patients, 687 nephrologists, 194 nurses, and 140 surgeons/radiologists. In an electronic questionnaire, respondents rated 42 vascular access-related topics on a 5-point Likert scale. Based on mean standardized ratings, we compared priority ratings between patients and each clinician group.Selection of access type and site, as well as prevention of access infections received top priority across all respondent groups. Patients generally assigned higher priority to decisions regarding managing adverse effects of arteriovenous access and patient involvement in care, while clinicians more often prioritized decisions around sustaining patients' access options, technical aspects of access creation, and optimizing fistula maturation and patency.Apart from identifying the most pressing knowledge gaps, our study provides pointers for developing guidelines that may improve healthcare professionals' understanding of when to involve patients along the vascular access pathway

Flow chart of process of identifying and prioritizing treatment decisions (i.e., topics) around permanent vascular access

<p>Flow chart of process of identifying and prioritizing treatment decisions (i.e., topics) around permanent vascular access</p

Participants’ characteristics.^a)

<p>Participants’ characteristics.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0128228#t001fn001" target="_blank">^a)</a></p

Comparing priority ratings between kidney patients and clinicians for topics to which <i>clinicians</i> assigned high priority, but that were absent in patients’ top 10.

<p>Abbreviations: N, number of respondents who rated the importance of a topic; SD, standard deviation</p

Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? An ERA-EDTA position statement

This paper reflects the position of the CKD-MBD workgroup, an official working group of ERA-EDTA and of the ERBP advisory board, the official guideline-producing body of ERA-EDTA, on the topic of the use of calcimimetics in patients with CKD stage 5D, as based on two recent meta-analysis