Identifying critically important vascular access outcomes for trials in haemodialysis: an international survey with patients, caregivers and health professionals

Viecelli AK 1 , Howell M 2 , Tong A 2 , Teixeira-Pinto A 2 , O'Lone E 2 , Ju A 2 Show all authors , Craig JC 3 , Hooi LS 4 , Lee T 5 , Lok CE 6 , Polkinghorne KR 7 , Quinn RR 8 , Vachharajani TJ 9 , Vanholder R 10 , Zuo L 11 , Tordoir J 12 , Pecoits-Filho R 13 , Yuo T 14 , Kopperschmidt P 15 , Smith R 16 , Irish AB 17 , Mori TA 18 , Pascoe EM 19 , Johnson DW 1 , Hawley CM 1

Affiliations 

  • 1 Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
  • 2 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  • 3 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
  • 4 Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
  • 5 Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
  • 6 Division of Nephrology, University Health Network, Toronto, ON, Canada
  • 7 Department of Nephrology, Monash Medical Centre, Melbourne, VC, Australia
  • 8 Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, AB, Canada
  • 9 Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
  • 10 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  • 11 Department of Nephrology, Peking University People's Hospital, Beijing, China
  • 12 Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
  • 13 School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
  • 14 Department of Surgery, Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  • 15 Fresenius Medical Care, Global Research & Development, Schweinfurt, Germany
  • 16 Nightcliff Renal Unit, Darwin, NT, Australia
  • 17 Department of Nephrology, Fiona Stanley Hospital, Perth, WA, Australia
  • 18 Medical School, University of Western Australia, Perth, WA, Australia
  • 19 Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
Nephrol Dial Transplant, 2020 04 01;35(4):657-668.
PMID: 31369099 DOI: 10.1093/ndt/gfz148

Abstract

BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes.

METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically.

RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle.

CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications