In Case You Missed It! October 2024
This month’s newsletter highlights new home dialysis training tools and psychosocial and biopsychosocial considerations in patients initiating dialysis and their respective outcomes:
- New continuous ambulatory peritoneal dialysis (CAPD) virtual reality (VR) patient training tool
- Why understanding patient coping methods matters
- Potential benefits associated with starting dialysis versus conservative care in older adult patients
Recent Findings
The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals
Authors conducted interviews with 5 nurses and 2 nephrologists, who each trained between 2 to 5 patients using a new VR CAPD patient training tool. Interview questions collected the clinician’s assessment of their patient’s satisfaction and learning success with the tool. Clinicians were also asked to provide any perceived drawbacks using the VR technology in the PD educational setting. Overall, clinicians highlighted 11 benefits and 3 drawbacks for various stakeholders. Key benefits included:
- Focused and “playful” learning environment for patients
- More effective time management (ability to multi-task) for healthcare professionals, but it cannot replace classical training
- Standardization of supplemental training programs for dialysis centers
Coping Model, Personality Traits, Social Support and Clinical Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: A Post-hoc Analysis of a Randomized Trial
A post-hoc analysis of a previous randomized controlled trial of 150 incident CAPD patients was conducted to examine results from the Medical Coping Modes Questionnaire (MCMQ) to identify leading patient coping mechanisms. Patients were grouped into one of three coping modes (avoidance, acceptance-resignation, or confrontation). The analysis examined associations between MCMQ coping modes, personality traits, and social support, with the primary outcome of all-cause mortality. Secondary outcomes included transfer to hemodialysis and first episode of peritonitis. These results suggest opportunities to integrate primary patient coping mechanisms into clinical practice.
Effect of Starting Dialysis Versus Continuing Medical Management on Survival and Home Time in Older Adults with Kidney Failure: A Target Trial Emulation Study
Investigators compared survival and home time in 20,440 adults aged 65 years or older who started conventional 3x/wk. hemodialysis versus those who elected to continue conservative care. The start of follow-up for each group was based on the day of the month when eGFR first fell below 12 mL/min/1.73m2 or first day of the month if their eGFR was below that threshold prior to the start of the month. Patients were followed until September 2018, or 36 months, whichever came first, and intent-to-treat and per protocol results (forgoing dialysis) were reported. Overall, 49% of patients who elected to continue medical management switched to dialysis during the 3-year study follow-up. The per protocol results identified a gain of 77.6 (CI 62.8 to 91.1) overall survival days coupled with 14.7 (CI 11.2 to 16.5) fewer days spent at home in the hemodialysis group suggesting that the trade-off between the two may be a meaningful consideration for shared decision making in older adults with advanced chronic kidney disease.
Related Resource
Treatment of Chronic Kidney Disease in Older Populations
DOI: 10.1038/s41581-024-00854-w
APM5138 Rev.A
