Publications by authors named "Edwina A Brown"
Article Synopsis
- This systematic review evaluates the role of intraperitoneal pressure measurements in predicting complications and gastrointestinal symptoms in Peritoneal Dialysis (PD) patients suffering from End-Stage Kidney Disease (ESKD).
- A total of 12 studies were analyzed, revealing a positive correlation between intraperitoneal pressure and Body Mass Index (BMI) and Body Surface Area (BSA), but less consistent results related to age and other factors.
- While the findings suggest a potential link between higher intraperitoneal pressure and BMI/BSA, the impact on non-infectious complications remains unclear, with noted limitations in the studies analyzed.
Article Synopsis
- - Use of peritoneal dialysis and home haemodialysis is low across Europe, especially in Eastern and Central Europe, despite their benefits for patients and healthcare systems; Scandinavian countries have the highest usage rates.
- - The low adoption rates are influenced by the dominance of the haemodialysis industry, which has led to more haemodialysis units and reimbursement practices favoring this method over home dialysis.
- - To improve home dialysis adoption, a shift in attitudes is necessary, focusing on meaningful patient activities rather than only biological outcomes, as highlighted by the Standardized Outcomes in Nephrology initiative.
Article Synopsis
- Peritoneal dialysis is recommended as a first-line treatment for kidney replacement, especially for vulnerable patients, but it often requires assistance that can involve family or specialized caregivers in institutional settings.
- A group of nephrologists from 13 European countries shared their insights on implementing assisted peritoneal dialysis, discussing the challenges and solutions that can help establish effective programs.
- The findings indicate that assisted peritoneal dialysis isn't a fixed approach and can be tailored to individual needs, allowing for flexible care options that can ultimately lead to greater patient autonomy.
Background: Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this.
View Article and Find Full Text PDFPeritoneal dialysis (PD) enables people to have a home-based therapy, permitting greater autonomy for individuals along with enhanced treatment satisfaction compared with in-center dialysis care. The burden of treatment on PD, however, remains considerable and underpins the need for person-centered care. This reflects the need to address the patient as a person with needs and preferences beyond just the medical perspective.
View Article and Find Full Text PDFHealth inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease.
View Article and Find Full Text PDFRationale & Objective: Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live.
Study Design: Scoping Review.
Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality. Routine symptom assessment is not universal or standardized in dialysis care.
View Article and Find Full Text PDFPeritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.
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- - Supportive care (SC) takes a person-centered approach to managing advanced chronic kidney disease (CKD), focusing on engaging patients and their caregivers in decisions about their care from the beginning.
- - Instead of concentrating solely on treating the disease, SC includes a variety of supportive interventions that aim to enhance the patient's overall quality of life, especially for older individuals with CKD who often value quality of life more than mere survival.
- - The review highlights the importance of SC as a complementary strategy to traditional disease-specific treatments for managing advanced CKD among older patients, who often face challenges like frailty and multiple health issues.
Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use.
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- A mixed-methods study explored gender differences among seriously unwell kidney disease patients on hemodialysis, focusing on their illness experiences, symptoms, and treatment expectations.
- The study involved 54 participants (36 males, 18 females) who shared their perspectives through structured interviews or questionnaires; data analysis revealed significant themes related to their hopes and fears surrounding treatment.
- Results indicated that males generally focused on physical goals while females sought to feel well, with both genders experiencing higher symptoms than expected, and over half reported regrets about starting dialysis, emphasizing the need for personalized care plans.
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions.
View Article and Find Full Text PDFEncapsulating peritoneal sclerosis (EPS) is a clinical syndrome hallmarked by the formation of a fibrous cocoon encapsulating the bowel resulting in morbidity and mortality. EPS is most frequently associated with peritoneal dialysis (PD), particularly with its discontinuation. While EPS is one of the most feared complications of PD, the majority of patients receiving PD will not go on to develop EPS.
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- The KTOP study investigates the experiences and outcomes of older kidney transplant recipients, focusing on frailty and cognitive impairment affecting their quality of life.
- In this observational study, participants aged 60 and above are assessed for frailty and cognition through various questionnaires and clinical data, which are collected at different stages of the transplantation process.
- Preliminary results show that 36.4% of participants exhibited cognitive impairment while 15.8% were identified as frail, highlighting significant vulnerabilities in this age group.
Article Synopsis
- A new two-exchange assisted continuous ambulatory peritoneal dialysis (asCAPD) program was created for older, frail patients who cannot manage autonomous dialysis and are too risky for hemodialysis.
- Data collected from 49 patients over four years demonstrated significant symptom improvement after 3 months, with reductions in anorexia, fatigue, shortness of breath, and edema.
- One-year survival rate was 55%, and the peritonitis occurrence was low (0.52 episodes per patient year), suggesting the program could be a viable option for frail patients with kidney failure, but more research is necessary.
Background: Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilized in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries.
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