Abstract
Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied “country-specific” factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a “one-size-fits-all” approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 37-47 |
| Number of pages | 11 |
| Journal | Kidney International |
| Volume | 96 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2019 |
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Keywords
- goal-directed dialysis
- hemodialysis
- home dialysis
- initiation
- modality
- peritoneal dialysis
- prescription
- symptom control
- vascular and peritoneal dialysis access
ASJC Scopus subject areas
- Nephrology
Cite this
Dialysis initiation, modality choice, access, and prescription : conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. / Chan, Christopher T.; Blankestijn, Peter J.; Dember, Laura M.; Gallieni, Maurizio; Harris, David C.H.; Lok, Charmaine E.; Mehrotra, Rajnish; Stevens, Paul E.; Wang, Angela Yee Moon; Cheung, Michael; Wheeler, David C.; Winkelmayer, Wolfgang C.; Pollock, Carol A.; Abu-Alfa, Ali K.; Bargman, Joanne M.; Bleyer, Anthony J.; Brown, Edwina A.; Davenport, Andrew; Davies, Simon J.; Finkelstein, Frederic O.; Flythe, Jennifer E.; Goffin, Eric; Golper, Thomas A.; Gómez, Rafael; Hamano, Takayuki; Hecking, Manfred; Heimbürger, Olof; Hole, Barnaby; Hothi, Daljit K.; Ikizler, T. Alp; Isaka, Yoshitaka; Iseki, Kunitoshi; Jha, Vivekanand; Kawanishi, Hideki; Kerr, Peter G.; Komenda, Paul; Kovesdy, Csaba P.; Lacson, Ed; Laville, Maurice; Lee, Jung Pyo; Lerma, Edgar V.; Levin, Nathan W.; Lichodziejewska-Niemierko, Monika; Liew, Adrian; Lindley, Elizabeth; Lockridge, Robert S.; Madero, Magdalena; Massy, Ziad A.; McCann, Linda; Meyer, Klemens B.; Morton, Rachael L.; Nadeau-Fredette, Annie Claire; Okada, Hirokazu; Perez, Jose; Perl, Jeff; Polkinghorne, Kevan R.; Riella, Miguel C.; Robinson, Bruce M.; Rocco, Michael V.; Rosansky, Steven J.; Rotmans, Joris I.; Fernanda Slon Roblero, María; Tangri, Navdeep; Tonelli, Marcello; Tong, Allison; Tsukamoto, Yusuke; Tungsanga, Kriang; Vachharajani, Tushar J.; van Loon, Ismay; Watnick, Suzanne; Weiner, Daniel E.; Wilkie, Martin; Zakharova, Elena.
In: Kidney International, Vol. 96, No. 1, 01.07.2019, p. 37-47.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Dialysis initiation, modality choice, access, and prescription
T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
AU - Chan, Christopher T.
AU - Blankestijn, Peter J.
AU - Dember, Laura M.
AU - Gallieni, Maurizio
AU - Harris, David C.H.
AU - Lok, Charmaine E.
AU - Mehrotra, Rajnish
AU - Stevens, Paul E.
AU - Wang, Angela Yee Moon
AU - Cheung, Michael
AU - Wheeler, David C.
AU - Winkelmayer, Wolfgang C.
AU - Pollock, Carol A.
AU - Abu-Alfa, Ali K.
AU - Bargman, Joanne M.
AU - Bleyer, Anthony J.
AU - Brown, Edwina A.
AU - Davenport, Andrew
AU - Davies, Simon J.
AU - Finkelstein, Frederic O.
AU - Flythe, Jennifer E.
AU - Goffin, Eric
AU - Golper, Thomas A.
AU - Gómez, Rafael
AU - Hamano, Takayuki
AU - Hecking, Manfred
AU - Heimbürger, Olof
AU - Hole, Barnaby
AU - Hothi, Daljit K.
AU - Ikizler, T. Alp
AU - Isaka, Yoshitaka
AU - Iseki, Kunitoshi
AU - Jha, Vivekanand
AU - Kawanishi, Hideki
AU - Kerr, Peter G.
AU - Komenda, Paul
AU - Kovesdy, Csaba P.
AU - Lacson, Ed
AU - Laville, Maurice
AU - Lee, Jung Pyo
AU - Lerma, Edgar V.
AU - Levin, Nathan W.
AU - Lichodziejewska-Niemierko, Monika
AU - Liew, Adrian
AU - Lindley, Elizabeth
AU - Lockridge, Robert S.
AU - Madero, Magdalena
AU - Massy, Ziad A.
AU - McCann, Linda
AU - Meyer, Klemens B.
AU - Morton, Rachael L.
AU - Nadeau-Fredette, Annie Claire
AU - Okada, Hirokazu
AU - Perez, Jose
AU - Perl, Jeff
AU - Polkinghorne, Kevan R.
AU - Riella, Miguel C.
AU - Robinson, Bruce M.
AU - Rocco, Michael V.
AU - Rosansky, Steven J.
AU - Rotmans, Joris I.
AU - Fernanda Slon Roblero, María
AU - Tangri, Navdeep
AU - Tonelli, Marcello
AU - Tong, Allison
AU - Tsukamoto, Yusuke
AU - Tungsanga, Kriang
AU - Vachharajani, Tushar J.
AU - van Loon, Ismay
AU - Watnick, Suzanne
AU - Weiner, Daniel E.
AU - Wilkie, Martin
AU - Zakharova, Elena
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied “country-specific” factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a “one-size-fits-all” approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
AB - Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied “country-specific” factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a “one-size-fits-all” approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
KW - goal-directed dialysis
KW - hemodialysis
KW - home dialysis
KW - initiation
KW - modality
KW - peritoneal dialysis
KW - prescription
KW - symptom control
KW - vascular and peritoneal dialysis access
UR - http://www.scopus.com/inward/record.url?scp=85064233683&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064233683&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2019.01.017
DO - 10.1016/j.kint.2019.01.017
M3 - Article
VL - 96
SP - 37
EP - 47
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 1
ER -