Timing of patient-reported renal replacement therapy planning discussions by disease severity among children and young adults with chronic kidney disease.

Autor: Ng DK; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. dng@jhu.edu., Xu Y; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Hogan J; Emory Transplant Center, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA., Saland JM; Department of Pediatrics, Kravis Children's Hospital, the Icahn School of Medicine at Mount Sinai, New York, NY, USA., Greenbaum LA; Department of Pediatrics, Emory School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA., Furth SL; Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Warady BA; Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA., Wong CS; Department of Pediatrics, Division of Nephrology, University of New Mexico Children's Hospital, Albuquerque, NM, USA.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2020 Oct; Vol. 35 (10), pp. 1925-1933. Date of Electronic Publication: 2020 May 03.
DOI: 10.1007/s00467-020-04542-2
Abstrakt: Background: Preparing children with chronic kidney disease (CKD) for renal replacement therapy (RRT) begins with a discussion about transplant and dialysis, but its typical timing in the course of CKD management is unclear. We aimed to describe participant-reported RRT planning discussions by CKD stage, clinical and sociodemographic characteristics, in the Chronic Kidney Disease in Children (CKiD) cohort.
Methods: Participants responded to the question "In the past year, have you discussed renal replacement therapy with your doctor or healthcare provider?" at annual study visits. Responses were linked to the previous year CKD risk stage based on GFR and proteinuria. Repeated measure logistic models estimated the proportion discussing RRT by stage, with modification by sex, age, race, socioeconomic status, and CKD diagnosis (glomerular vs. non-glomerular).
Results: A total of 721 CKiD participants (median age = 12, 62% boys) contributed 2856 person-visits. Proportions of person-visits reporting RRT discussions increased as CKD severity increased (10% at the lowest disease stage and 87% at the highest disease stage). After controlling for CKD risk stage, rates of RRT discussions did not differ by sex, age, race, and socioeconomic status.
Conclusions: Despite participant-reported RRT discussions being strongly associated with CKD severity, a substantial proportion with advanced CKD reported no discussion. While recall bias may lead to underreporting, it is still meaningful that some participants with severe CKD did not report or remember discussing RRT. Initiating RRT discussions early in the CKD course should be encouraged to foster comprehensive preparation and to align RRT selection for optimal health and patient preferences.
Databáze: MEDLINE
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