Barriers to conservative care from patients' and nephrologists' perspectives: the CKD-REIN study.
chronic kidney disease
comprehensive conservative care
conservative care
kidney failure
supportive care
Journal
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402
Informations de publication
Date de publication:
23 11 2022
23 11 2022
Historique:
received:
25
06
2021
pubmed:
14
1
2022
medline:
25
11
2022
entrez:
13
1
2022
Statut:
ppublish
Résumé
Conservative care is increasingly considered an alternative to kidney replacement therapy for kidney failure management, mostly among the elderly. We investigated its status and the barriers to its implementation from patients' and providers' perspectives. We analysed data from 1204 patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] enrolled at 40 nationally representative nephrology clinics (2013-16) who completed a self-administered questionnaire about the information they received and their preferred treatment option, including conservative care, if their kidneys failed. Nephrologists (n = 137) also reported data about their clinics' resources and practices regarding conservative care. All participating facilities reported they were routinely able to offer conservative care, but only 37% had written protocols and only 5% had a person or team primarily responsible for it. Overall, 6% of patients were estimated to use conservative care. Among nephrologists, 82% reported they were fairly or extremely comfortable discussing conservative care, but only 28% usually or always offered this option for older (>75 years) patients approaching kidney failure. They used various terminology for this care, with conservative management and non-dialysis care mentioned most often. Among patients, 5% of those >75 years reported receiving information about this option and 2% preferring it. Although reported by nephrologists to be widely available and easily discussed, conservative care is only occasionally offered to older patients, most of whom report they were not informed of this option. The lack of a person or team responsible for conservative care and unclear information appear to be key barriers to its implementation.
Sections du résumé
BACKGROUND
Conservative care is increasingly considered an alternative to kidney replacement therapy for kidney failure management, mostly among the elderly. We investigated its status and the barriers to its implementation from patients' and providers' perspectives.
METHODS
We analysed data from 1204 patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] enrolled at 40 nationally representative nephrology clinics (2013-16) who completed a self-administered questionnaire about the information they received and their preferred treatment option, including conservative care, if their kidneys failed. Nephrologists (n = 137) also reported data about their clinics' resources and practices regarding conservative care.
RESULTS
All participating facilities reported they were routinely able to offer conservative care, but only 37% had written protocols and only 5% had a person or team primarily responsible for it. Overall, 6% of patients were estimated to use conservative care. Among nephrologists, 82% reported they were fairly or extremely comfortable discussing conservative care, but only 28% usually or always offered this option for older (>75 years) patients approaching kidney failure. They used various terminology for this care, with conservative management and non-dialysis care mentioned most often. Among patients, 5% of those >75 years reported receiving information about this option and 2% preferring it.
CONCLUSIONS
Although reported by nephrologists to be widely available and easily discussed, conservative care is only occasionally offered to older patients, most of whom report they were not informed of this option. The lack of a person or team responsible for conservative care and unclear information appear to be key barriers to its implementation.
Identifiants
pubmed: 35026014
pii: 6506464
doi: 10.1093/ndt/gfac009
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2438-2448Investigateurs
Natalia Alencar de Pinho
(NA)
Carole Ayav
(C)
Serge Briançon
(S)
Dorothée Cannet
(D)
Christian Combe
(C)
Denis Fouque
(D)
Luc Frimat
(L)
Yves-Edouard Herpe
(YE)
Christian Jacquelinet
(C)
Maurice Laville
(M)
Ziad A Massy
(ZA)
Christophe Pascal
(C)
Bruce M Robinson
(BM)
Bénédicte Stengel
(B)
Céline Lange
(C)
Karine Legrand
(K)
Sophie Liabeuf
(S)
Marie Metzger
(M)
Elodie Speyer
(E)
Thierry Hannedouche
(T)
Bruno Moulin
(B)
Sébastien Mailliez
(S)
Gaétan Lebrun
(G)
Eric Magnant
(E)
Gabriel Choukroun
(G)
Benjamin Deroure
(B)
Adeline Lacraz
(A)
Guy Lambrey
(G)
Jean Philippe Bourdenx
(J)
Marie Essig
(M)
Thierry Lobbedez
(T)
Raymond Azar
(R)
Hacène Sekhri
(H)
Mustafa Smati
(M)
Mohamed Jamali
(M)
Alexandre Klein
(A)
Michel Delahousse
(M)
Christian Combe
(C)
Séverine Martin
(S)
Isabelle Landru
(I)
Eric Thervet
(E)
Ziad A Massy
(ZA)
Philippe Lang
(P)
Xavier Belenfant
(X)
Pablo Urena
(P)
Carlos Vela
(C)
Luc Frimat
(L)
Dominique Chauveau
(D)
Victor Panescu
(V)
Christian Noel
(C)
François Glowacki
(F)
Maxime Hoffmann
(M)
Maryvonne Hourmant
(M)
Dominique Besnier
(D)
Angelo Testa
(A)
François Kuentz
(F)
Philippe Zaoui
(P)
Charles Chazot
(C)
Laurent Juillard
(L)
Stéphane Burtey
(S)
Adrien Keller
(A)
Nassim Kamar
(N)
Denis Fouque
(D)
Maurice Laville
(M)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.