Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Authors:
Christopher T Chan
Christopher T Chan
University Health Network
Toronto | Canada
Peter J Blankestijn
Peter J Blankestijn
University Medical Center Utrecht
Netherlands
Laura M Dember
Laura M Dember
Boston University School of Medicine
United States
Maurizio Gallieni
Maurizio Gallieni
University of Milan
Italy
Charmaine E Lok
Charmaine E Lok
University of Toronto
Canada
Rajnish Mehrotra
Rajnish Mehrotra
University of Washington

Kidney Int 2019 Jul 13;96(1):37-47. Epub 2019 Apr 13.

University of Sydney, Sydney, NSW, Australia. Electronic address:

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.

Download full-text PDF

Source
https://linkinghub.elsevier.com/retrieve/pii/S00852538193013
Publisher Site
http://dx.doi.org/10.1016/j.kint.2019.01.017DOI Listing
July 2019
18 Reads

Publication Analysis

Top Keywords

dialysis initiation
12
kidney disease
12
disease improving
8
access prescription
8
global outcomes
8
choice access
8
controversies conference
8
modality choice
8
dialysis
8
improving global
8
health care
8
treatment january
4
decisions treatment
4
care
4
goals care
4
care decisions
4
diverse health
4
2018 kdigo
4
focused dialysis
4
initiation including
4

Altmetric Statistics

Similar Publications