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).

项目摘要/摘要 存在几种形式的肾脏替代疗法（RRT）来帮助ESKD患者，但它们并不相等 理想的是，通常比中心血液透析的家庭透析和肾脏移植。 最好的证据表明，与中心透析相比，先发制人的肾脏移植 在家透析方式与更好的生活质量，相同或更好的生存有关，并且更多 成本效益。注意到这些好处，美国卫生与公共服务部启动了 该计划于2019年推进美国肾脏健康计划。该计划的目标是拥有80％的ESKD 到2025年，家庭透析患者或接受先发制人的移植。然而，根据美国肾脏数据 系统，2018年只有14％的ESKD诊断患者使用家庭透析模式或接受 先发制人的移植，承诺大多数患者在医学和心理上都有资格 对于这些选项。 在某种程度上，这可能是由于RRT要求将新的医疗保健“工作量”实施的工作造成 他们的生活。对于家庭透析，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，专业人士在中心透析设施中发现。在移植的情况下，患者通常是 由于缺乏对免疫抑制，财务和 遵循移植的关系。当治疗工作量超过患者容量时，定义为患者 能力和资源获得和使用医疗服务并在家中进行自我保健，患者处于危险之中 对于较差的结果。这些结果部分是由不可持续的治疗驱动的，伯恩定义为 患者询问的客观治疗工作以及主观的负面社会和情感后果。 伯嫩治疗与患者的不遵守相关，并被发现影响多达40％ 患有慢性疾病的患者。有大量证据表明患者容量是可修改的结构 并且与CKD护理有关。它是通过患者与他们的传记（自我和生活的感觉）互动而创建的 角色），资源，环境，患者工作的经验和社交网络。 在拟议的研究中，我们将确定患者的能力是否在肾衰竭的CKD患者中， 与RRT的选择相关（AIM 1）。我们还将在RRT上的ESKD患者中确定是否 更高的容量预测转换为更理想形式的RRT和较低容量预测的转换转换为A RRT的理想形式不太理想或退出RRT（AIM 2）。最后，这项研究将决定 CKD/ESKD患者在医学上有资格接受移植，如果患者的能力是移植转诊的预后， 移植批准或移植等待名单上的死亡（AIM 3）。