The Role of Patient Capacity in Chronic Kidney Disease Trajectories

患者能力在慢性肾脏病轨迹中的作用

• 批准号: 10737920
• 负责人: Kasey Boehmer
• 金额: $ 15.15万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-24 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10737920
• 关键词: Adult; Affect; American; Applied Skills; Award; Biography; Blood; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Clinical; Diagnosis; Dialysis procedure; Eligibility Determination; Emotional; Environment; Epidemiology; Evaluation; Funding; Goals; Health; Health Professional; Healthcare; Hemodialysis; Home; Immunosuppression; Information Systems; Intervention; Isoantibodies; Kidney; Kidney Failure; Kidney Transplantation; Life; Measures; Medical; Methods; Modality; Modeling; Obesity; Outcome; Patient Noncompliance; Patient Selection; Patients; Population; Quality of life; Renal Replacement Therapy; Research; Research Personnel; Resources; Risk; Role; Self Care; Shoulder; Social Network; Statistical Models; Testing; Training; Transplant Recipients; Transplantation; United States; United States Dept. of Health and Human Services; Veins; Waiting Lists; Work; Workload; clinical care; clinical predictive model; clinically relevant; comorbidity; coping; cost effective; experience; health care service utilization; hospice environment; implementation science; observational cohort study; patient oriented; prognostic; programs; prospective; psychosocial; skills; social

PROJECT SUMMARY/ABSTRACT Several forms of renal replacement therapy (RRT) exist to help patients with ESKD, but they are not equally desirable, with in-home dialysis and kidney transplantation being generally preferable to in-center hemodialysis. The best evidence available indicates that, compared to in-center dialysis, pre-emptive kidney transplantation and at-home dialysis modalities are associated with better quality of life, same or better survival, and are more cost-effective. Noting these benefits, the U.S. Department of Health and Human Services launched the Advancing American Kidney Health initiative in 2019. This program proposed a target of having 80% of ESKD patients on home dialysis or receiving a preemptive transplant by 2025. Yet, according to the U.S. Renal Data System, only 14% of patients diagnosed with ESKD in 2018 utilized a home dialysis modality or received preemptive transplant, despite the fact that the majority of patients are both medically and psychosocially eligible for these options. In part, this may be due to the work that RRT requires of patients to implement new healthcare “workload” into their lives. In the case of home dialysis, patients must shoulder these new tasks without the help of healthcare professionals traditionally found at in-center dialysis facilities. In the case of transplant, patients are often surprised by the lack of a return to “normal life” due challenges with immunosuppression, finances, and relationships that follow transplant. When treatment workload exceeds patient capacity, defined as patients’ abilities and resources to access and use healthcare services and enact self-care at home, patients are at risk for poorer outcomes. These outcomes are in part driven by unsustainable treatment burden, defined as the objective treatment work asked of patients and the subjective negative social and emotional consequences. Treatment burden is correlated with patient non-adherence and has been found to affect as many as 40% of all patients with chronic conditions. There is considerable evidence that patient capacity is a modifiable construct and relevant to CKD care. It is created through patient interaction with their biography (sense of self and life roles), resources, environment, experience of patient work, and social network. In the proposed study we will determine if patient capacity, among CKD patients who progress to kidney failure, correlates with the choice of RRT (Aim 1). We will also determine amongst ESKD patients on RRT whether higher capacity predicts the switch to a more desirable form of RRT and lower capacity predicts the switch to a less desirable form of RRT or withdrawing from RRT (Aim 2). Finally, this study will determine amongst CKD/ESKD patients medically eligible for transplant if patient capacity is prognostic for transplant referral, transplant approval, or death on the transplant wait list (Aim 3).

项目概要/摘要 存在多种形式的肾脏替代疗法 (RRT) 来帮助 ESKD 患者，但它们的效果并不相同 家庭透析和肾移植通常优于中心血液透析。 现有的最佳证据表明，与中心透析相比，先发制人的肾移植 家庭透析方式与更好的生活质量、相同或更好的生存率相关，并且更有效。 注意到这些好处，美国卫生与公众服务部推出了 2019 年推进美国肾脏健康计划。该计划提出了 80% 的 ESKD 目标 到 2025 年，患者将接受家庭透析或接受先发性移植。然而，根据美国肾脏数据 系统显示，2018 年诊断为 ESKD 的患者中只有 14% 使用家庭透析方式或接受透析治疗 尽管大多数患者在医学上和社会心理上都符合条件，但仍进行先发性移植 对于这些选项。 在某种程度上，这可能是由于 RRT 要求患者将新的医疗“工作量”实施到 在家庭透析的情况下，患者必须在没有医疗保健帮助的情况下承担这些新任务。 传统上，在中心透析设施中配备的专业人员在移植的情况下，通常是患者。 由于免疫抑制、财务和经济方面的挑战，未能恢复“正常生活”感到惊讶 当治疗工作量超过患者的承受能力（定义为患者的能力）时，移植后的关系。 患者有能力和资源获得和使用医疗保健服务以及在家进行自我护理，因此患者面临风险 这些结果部分是由不可持续的治疗负担造成的，定义为 治疗要求患者客观工作和主观负面社会和情感后果。 治疗负担与患者不依从性相关，并且已发现影响多达 40% 的患者 有大量证据表明，患者的能力是可以改变的。 并与 CKD 护理相关。它是通过患者与其传记（自我意识和生活意识）的互动而创建的。 角色）、资源、环境、患者工作经验和社交网络。 在拟议的研究中，我们将确定进展为肾衰竭的 CKD 患者中的患者能力是否 与 RRT 的选择相关（目标 1）。我们还将确定 ESKD 患者是否接受 RRT。 较高的容量预示着会转向更理想的 RRT 形式，较低的容量预示着会转向更理想的 RRT 形式。 不太理想的 RRT 形式或退出 RRT（目标 2）。 如果患者的能力可以预测移植转诊，则 CKD/ESKD 患者在医学上符合移植条件， 移植获得批准，或在移植等待名单上死亡（目标 3）。