Chronic Kidney Disease Care Research Articles

Sex and gender differences in ambulatory care of chronic kidney disease

Sex and gender differences in ambulatory care of chronic kidney disease

Adaptation to Telehealth of Personalized Group Visits for Late Stage Diabetic Kidney Disease.

The COVID-19 pandemic resulted in an unprecedented shift in the delivery of outpatient medical care, including the rapid transition of services from in-person to telehealth. We adapted an evidence-based personalized health planning group visit care model traditionally offered in-person to telehealth to support the care of patients with type 2 diabetes mellitus (T2D) and chronic kidney disease (CKD). Despite the need to leverage telehealth technologies to better support self-management for patients with CKD, scant evidence exists on how to do so. We conducted prospective adaptations of in-person evidence-based group visit model for telehealth delivery for patients with CKD and T2D. Intervention adaptations are reported using the Framework for Reporting Adaptations and Modifications (FRAME) taxonomy. The adapted virtual group visit care model was pilot tested among adults with T2D and stage 3b or 4 CKD. Feasibility outcomes included recruitment, attendance, satisfaction, and self-reported goal progress. Clinical outcomes were evaluated using Wilcoxon signed rank tests and included hemoglobin A1C (HbA1c), diastolic and systolic blood pressure, body mass index, and estimated glomerular filtration rate. Adaptation areas included outreach, visit format, educational materials design and access, staffing, and patient engagement strategies. 39% (43) of patients (110) contacted verbalized interest, and 58% (25) of those participated. 72% completed >6 group sessions. 68% of patients reported completing one or more health goals, with nutrition and physical activity being the most common. We observed a statistically significant improvement in HbA1c (p = 0.0176) six months post-program participation. Adapting evidence-based interventions for telehealth delivery is challenging due to the risk of altering an intervention's core components responsible for observed benefits. We adapted an in-person group visit model for the care of T2D and CKD for telehealth delivery. The telehealth approach was feasible and preliminary data suggested it improved relevant health and patient-recorded outcomes up to six months post-program completion. The approaches used here may be applicable to the adaptation of other clinical programs for telehealth delivery.

Economic evaluation of dialysis and comprehensive conservative care for chronic kidney disease using the ICECAP-O and EQ-5D-5L; a comparison of evaluation instruments

BackgroundChronic Kidney Disease (CKD) patients often require long-term care, and while Hemodialysis (HD) is the standard treatment, Comprehensive Conservative Care (CCC) is gaining popularity as an alternative. Economic evaluations comparing their cost-effectiveness are crucial. This study aims to perform a cost-utility analysis comparing HD and CCC using the EQ-5D-5L and ICECAP-O instruments to assessing healthcare interventions in CKD patients.MethodsThis short-term economic evaluation involved 183 participants (105 HD, 76 CCC) and collected data on demographics, comorbidities, laboratory results, treatment costs, and HRQoL measured by ICECAP-O and EQ-5D-5L. Incremental Cost-Effectiveness Ratios (ICERs) and Net Monetary Benefit (NMB) were calculated separately for each instrument, and Probabilistic Sensitivity Analysis (PSA) assessed uncertainty.ResultsCCC demonstrated significantly lower costs (mean difference $8,544.52) compared to HD. Both EQ-5D-5L and ICECAP-O indicated higher Quality-Adjusted Life Years (QALYs) for both groups, but the difference was not statistically significant (p > 0.05). CCC dominated HD in terms of HRQoL measures, with ICERs of -$141,742.67 (EQ-5D-5L) and -$4,272.26 (ICECAP-O). NMB was positive for CCC and negative for HD, highlighting its economic feasibility.ConclusionCCC proves a preferable and more cost-effective treatment option than HD for CKD patients aged 65 and above, regardless of the quality-of-life measure used for QALY calculations. Both EQ-5D-5L and ICECAP-O showed similar results in cost-utility analysis.

Patient-Reported Outcome Measures for Patients With CKD: The Case for Patient-Reported Outcomes Measurement Information System (PROMIS) Tools

Chronic kidney disease (CKD), kidney failure, and kidney replacement therapies are associated with high symptom burden and impaired health-related quality of life (HRQOL). Symptoms change with disease progression or transition between treatment modalities and frequently go unreported and unmanaged. Tools that reliably monitor symptoms may improve the management of patients with CKD. Patient-reported outcome measures (PROMs) assess symptom severity; physical, psychological, social, and cognitive functioning; treatment-related side effects; and HRQOL. Systematic use of PROMs can improve patient-provider communication, patient satisfaction, clinical outcomes, and HRQOL. Potential barriers to their use include a lack of engagement, response burden, and limited guidance about PROM collection, score interpretation, and workflow integration. Well-defined, acceptable, and effective clinical response pathways are essential for implementing PROMs. PROMs developed by the Patient-Reported Outcomes Measurement Information System (PROMIS) address some challenges and may be suitable for clinical use among patients with CKD. PROMIS tools assess multiple patient-valued, clinically actionable symptoms and functions. They can be administered as fixed-length, customized short forms or computer adaptive tests, offering precise measurement across a range of symptom severities or function levels, tailored questions to individuals, and reduced question burden. Here we provide an overview of the potential use of PROMs in CKD care, with a focus on PROMIS.

Referral Criteria to Specialist Palliative Care for People with Advanced Chronic Kidney Disease: A Systematic Review.

People with advanced chronic kidney disease (CKD) have significant morbidity, yet for many, access to palliative care occurs late, if at all. This study sought to examine criteria for referral to specialist palliative care for adults with advanced CKD with a view to improving use of these essential services. Systematic review of studies detailing referral criteria to palliative care in advanced CKD conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline and registered (PROSPERO: CRD42021230751). Electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed) were used to identify potential studies, which were subjected to double review, data extraction, thematic coding, and descriptive analyses. Searches yielded 650 unique titles ultimately resulting in 56 studies addressing referral criteria to specialist palliative care in advanced CKD. Of 10 categories of referral criteria, most commonly discussed were: Critical times of treatment decision making (n = 23, 41%); physical or emotional symptoms (n = 22, 39%); limited prognosis (n = 18, 32%); patient age and comorbidities (n = 18, 32%); category of CKD/ biochemical criteria (n = 13, 23%); functional decline (n = 13, 23); psychosocial needs (n = 9, 16%); future care planning (n = 9, 16%); anticipated decline in illness course (n = 8, 14%); and hospital use (n = 8, 14%). Clinicians consider referral to specialist palliative care for a wide range of reasons, with many related to care needs. As palliative care continues to integrate with nephrology, our findings represent a key step towards developing consensus criteria to standardize referral for patients with chronic kidney diseases.

The care trajectories leading to emergency dialysis start: a qualitative study

Abstract Introduction Emergency dialysis start (EDS) is an important issue to understand and tackle in Chronic Kidney Disease (CKD) care. Late referral, absent previous nephrology care and higher comorbidity scores have been associated with EDS. However, how those factors happen and contribute to EDS remains unexplored. We conducted a qualitative study in France to identify and describe the mechanisms that shape the trajectories that lead to EDS, using patients, GPs and nephrologists perspectives. Methods Three groups of participants were recruited in Brittany, north-west France: Patients who started dialysis in emergency between 2017 and 2019, GPs and nephrologists. Maximum variation sampling approach was used based on patients’ socio-economic profiles and GPs’ and nephrologists’ years and settings of practice. Semi-structured interviews were conducted between 2017 and 2020. A crossed thematic analysis between the 3 groups of transcripts was performed, informing how EDS trajectories come to be. Results Twenty patients, 12 GPs and 18 nephrologists were interviewed. Five themes were identified: 1) Learning about dialysis, 2) Dialysis and nephrology care representations: a) an unacceptable biographical disruption, b) a dreadful invasive machinery, c) a straw that breaks the camel's back, 3) The gap between the “illness” perceived and the “disease” treated, 4) Slipping through the primary care prevention net, 5) the unavoidable unpredictability of CKD course. Conclusions This study shows how EDS is, in part, the results of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology. The results suggests a need for evaluation of kidney replacement therapy education programs and reinforcement of psychological care. Finally, results support ambitious mass prevention campaign focused on kidney health to counter the persistent negative representation of dialysis and seal off prevention cracks. Key messages • Emergency dialysis start is the result of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology. • Evaluation of kidney replacement therapy education programs and reinforcement of psychological care as well as an ambitious prevention campaign focused on kidney health could contribute to reduce EDS.

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation.

Cigarette smoking is a critical issue in caring for patients of chronic kidney disease (CKD). However, there is no routine care program designed for combining both smoking cessation and CKD care. The process of our quality improvement (QI) collaboration used data under our routine payment-for-performance for pre-end-stage renal disease (P4P Pre-ESRD) in Taichung Veterans General hospital from 2020 to 2022. We share our experience with a QI project that integrates the Ottawa model for smoking cessation (OMSC) with the Pre-ESRD care program as part of routine CKD care. The electronic health information systems were improved to reduce workload of medical staff. The number was more for both qualified CKD educators and nephrologists for smoking cessation. The access and availability for smoking cessation were immediate and convenient for patients. Specifically, all the actions were performed by CKD educators, with nephrologists overseeing the process in routine care. By combining OMSC with the Pre-ESRD program, we were able to provide smokers with satisfactory access and availability to smoking cessation services within our healthcare facility. The smoker cases found were more in number (206 in 2020, 344 in 2021, and 421 in 2022). Before the integrated OSTC-Pre-ESRD program (in 2020), the proportion of smokers was 3.88%. After implementing the integrated program, smokers increased significantly on a yearly basis (9.69% in 2021 and 9.82% in 2022). Finally, case numbers of on-site smoking cessations increased significantly after implementing the integrated system (0 in 2020, 17 in 2021, and 20 in 2022). All CKD patients for smoking cessation were also more (8 in 2020, 46 in 2021, and 38 in 2022). After implementing the QI program, focusing on the integrated OMSC-Pre-ESRD program, we found more smokers undergoing smoking cessation. This QI program highlighted the importance of better access and availability for smoking cessation.

An introduction to realist evaluation and synthesis for kidney research

Realist research describes a methodological approach that aims to explore how and why interventions work, for whom, and under what circumstances. Rather than quantifying how well an intervention works under specific conditions, realist theory explores the function of interventions in detail and specifically considers how the contexts in which interventional components are delivered influence the mechanisms that lead to outcomes. Realist methods can be applied to primary data (realist evaluation) or secondary data (realist synthesis). Although realist techniques are increasingly being used in the evaluation of complex interventions, there are relatively few published studies in the field of kidney care. In this review, we outline the theory and principles behind realist methods through discussion of a published realist synthesis describing complex interventions promoting delivery of optimal chronic kidney disease care. We discuss other kidney studies that have used realist methodology and situations where realist techniques could be applied to advance our understanding of how to best deliver care to patients with kidney disease.

Challenging Health Inequities in Incarceration: a Call for Equitable Care for Kidney Disease and Hypertension.

To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes. There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons. Furthermore, more data is needed to understand the impact of structural racism in the criminal legal system on overall disparities in care for hypertension and kidney disease. Insurance coverage rates for people who were formerly incarcerated continue to be lower than the general population despite Medicaid expansion in many states. There is little recent data regarding kidney replacement therapy for this population despite known variation in dialysis modalities and transplant programs by state. Transitions clinics, which connect people who were formerly incarcerated with care in the community upon release, are growing and are important avenues by which to deliver care. People who are incarcerated are disproportionately affected by hypertension and kidney disease, yet data regarding the extent of these inequities and availability of quality care is lacking. More work is needed to understand the care of individuals with kidney disease and hypertension in prisons and to improve outcomes for these common chronic conditions. Both providing effective treatment of kidney disease and hypertension in prisons and jails and providing coordinated, quality transition to community care upon release represents an important opportunity for reform in care for a marginalized population.

Cardiorenal care coordination: holistic patient care opportunities in the primary care setting for patients with chronic kidney disease and atherosclerotic cardiovascular disease

ABSTRACT Objectives Chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) are closely linked conditions, and the presence of each condition promotes incidence and progression of the other. In this study, we sought to better understand the medical journey of patients with CKD and ASCVD and to uncover patients’ and healthcare providers’ (HCPs) perceptions and attitudes toward CKD and ASCVD diagnosis, treatment, and care coordination. Methods Cross-sectional, US-population-based online surveys were conducted between May 18, 2021, and June 17, 2021, among 239 HCPs (70 of whom were primary care physicians, or PCPs) and 195 patients with CKD and ASCVD. Results PCPs reported personally diagnosing CKD in 78% and ASVD in 64% of their patients, respectively. PCPs reported they are more likely to serve as the overall coordinator of their patient’s care (89%), while slightly more than half of PCPs self-identified as a patient’s coordinator of care specifically for CKD (54%) or ASCVD (59%). In contrast, patients viewed their PCP as their coordinator of care for CKD (25%) or ASCVD (9%). PCPs who personally treated patients with CKD and ASCVD most often recalled primarily prescribing or recommending pharmacologic treatments for CKD and ASCVD; however, patients reported that lifestyle modification was the most common treatment modality they had ever used to manage CKD and ASCVD. Conclusion CKD and ASCVD are interrelated cardiometabolic conditions with underlying risk factors that can be managed in a primary care setting. However, few patients in our study considered their PCP to be the coordinator of their care for CKD or ASCVD. PCPs can and should take a more active role in educating patients and coordinating care for those with CKD and ASCVD.

Quality of care in chronic kidney disease from the perspective of the family doctor. A qualitative study

Antecedentes. La visión del médico familiar en la calidad de la atención de la enfermedad renal crónica (ERC) es fundamental. La identificación de fortalezas y puntos críticos permitirá el desarrollo de mejoras en favor de los pacientes. Objetivo. Explorar las perspectivas de calidad del médico de familia en el manejo de la enfermedad renal crónica en una unidad de primer nivel en Tabasco, México. Materiales y métodos. Investigación cualitativa bajo el enfoque interpretativo realizada en dos grupos focales (12 médicos familiares en atención directa a pacientes con ERC), como marco metodológico se empleó el Modelo de Avedis Donabedian: Estructura, Proceso y Resultados, y en el análisis de los datos se empleó el software MAXQDA versión 2020. Resultados. Los médicos familiares identificaron falta de material y equipo para la atención y medicamentos esenciales para los pacientes, inaccesibilidad a exámenes de laboratorio, recursos humanos insuficientes, falta de evaluación y supervisión, desvinculación con segundo nivel, desapego al tratamiento, baja corresponsabilidad del paciente y nulo apoyo de la familia. Conclusión. Explorar las perspectivas de los médicos familiares permitió identificar deficiencias que bien tratadas se convierten en áreas de oportunidad prioritarias para la mejora continua de los servicios de salud.

The Impact of Virtual Reality (VR) Gaming and Casual/Social Gaming on the Quality of Life, Depression, and Dialysis Tolerance in Patients With Chronic Kidney Disease: A Narrative Review.

This comprehensive narrative review aims to investigatethe impact of virtual reality (VR) and social gaming on the quality of life, depression, and dialysis tolerance in patients with chronic kidney disease (CKD), a growing global health concern affecting the quality of life and increasing mortality rates. Through a combination of exercise and video games, exergaming, and digital game therapy (DGT), sedentary risks can be mitigated and therapy adherenceenhanced. Despite potential side effects such as exhaustion and nausea, research indicates that virtual therapeutic games improve motivationand dialysis tolerance, and even reduce brain activity in pain-associated regions during procedures. These methods are superior to traditional distraction techniques like music, movies, and toys. Exergaming, social gaming, and VR gaming can improve various health factors including depressive symptoms, functional capacity, muscle strength, fatigue, physical activity, mental health, motivation, engagement, cognition, and overall quality of life for CKD patients. Representing a novel approach to CKD management, these interventions promote physical activity, cognitive stimulation, and social interaction. Continued research and innovation will facilitate the integration of VR-based therapies into routine CKD care.

Healthcare professionals’ perspectives of the management of people with palliative care needs in the emergency department of a UK hospital

BackgroundThe Emergency Department (ED) is not always the optimal place for people with palliative care needs but is the most common route for treatment when urgent care is sought. The aim of this study,’’REasons for PalLIative Care Admissions (REPLICA)’ was to explore the perspectives of ED healthcare professionals of hospital admission or discharge via ED for palliative care patients.MethodsThis is a sequential mixed methods study comprising (i) quantitative descriptive analysis of Hospital Episode Statistics (HES) of palliative care patients (code Z51.5) who were admitted through ED in a West Midlands Hospital and for the rest of England; (ii) in-depth semi-structured interviews with 17 ED staff which were analysed using thematic content analysis.ResultsOver the four years (2013–2017), 430,116 people admitted through ED were identified with a Z51.5 diagnosis code, 0.6% (n = 2736) of whom were from the West Midlands Hospital. The most common reasons for palliative care patients’ admission to hospitals across England were for care of chronic kidney disease, cancers and urinary tract infections. Five themes were elicited from the qualitative analysis: (1) Providing palliative care in ED is challenging, due to factors including lack of training in palliative care and the unsuitable environment. (2) Patients go to ED due to challenges in community management such as inappropriate referrals and no care plan in place. (3) Health system influences admission and discharge decisions, including bed availability and being unable to set up community services out-of-hours. (4) Discussion with patient about treatment and end of life care needs to be outside of ED whilst the patient is still well enough to express their wishes. (5) Improving services for patients with palliative care needs. Recommendations include short training sessions for ED staff and accessing palliative care professionals 24/7.ConclusionsA large number of palliative care patients visit ED and are admitted to hospital for care; there is an urgent need to prevent patients attending the hospital through the establishment of a coordinated and dedicated service to support palliative care patients in the community.

Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990-2019.

Chronic kidney disease (CKD) imposes a heavy obscure burden on individuals and health systems. Besides its burden, the quality of care of CKD is less well investigated. In this study, we aimed to explore the global, regional and national trends of CKD burden and quality of care. The Global Burden of Disease Study 2019 data were used. Trends of incidence, prevalence, deaths and disability-adjusted life years were studied for the 1990-2019 period in the global aspect. By generating four secondary indices to assess different aspects of quality of care the quality of care index (QCI) was developed to explore the care provided for CKD. Inequities and disparities between various geographic, socio-demographic and age stratifications, and sex were studied using the QCI values. In 2019, there were 18986903 (95% uncertainty interval 17556535 to 20518156) incident cases of CKD, globally. The overall global QCI score had increased slightly from 78.4 in 1990 to 81.6 in 2019, and it was marginally better in males (QCI score 83.5) than in females (80.3). The highest QCI score was observed in the European region with a score of 92.5, while the African region displayed the lowest QCI with 61.7. Among the age groups, the highest QCI was for children aged between 5 and 9 years old (92.0), and the lowest was in the age group of 20-24 year olds (65.5). This study revealed that significant disparities remain regarding the quality of care of CKD, and to reach better care for CKD, attention to and care of minorities should be reconsidered. The evidence presented in this study would benefit health policymakers toward better and more efficient control of CKD burden alongside improving the care of this condition.

Nursing Care of Chronic Kidney Disease with Activity Intolerance Nursing Problems: A Case Study

Nursing care for patients who experienced chronic kidney disease with intolerance of activities and nursing problems in the Bougenville Room at Dr.H.Koesnadi General Hospital, Bondowoso Regency. Chronic Kidney Disease (CKD) is an irreversible disease that develops slowly and progressively. The main factor causing this disease is adults with Diabetes Mellitus and Hypertension. Symptoms are pain, hematuria, anuria, and anemia. This of course results in a feeling of weakness and fatigue so that the problem of Activity Intolerance can arise. This study aims to carry out nursing care for clients who experience chronic kidney disease with activity intolerance nursing problems. The research design was a case study of one patient with chronic kidney disease with Activity Intolerance nursing problems in the internal care room (Bougenvile) Dr.H. Koesnadi Bondowoso. Data was collected on 15-16 May 2023 using interviews, observation, physical examination, documentation studies, and questionnaire techniques. The results of this study were obtained from the assessment, which then formulated a diagnosis in accordance with the theoretical review. Nursing interventions using SIKI adapted to the client's conditions, implementation, and evaluation referring to the results criteria obtained are 99% O2 saturation, RR 19 x/minute, decreased complaints of fatigue, and decreased feeling of weakness. Clients are expected to always maintain their health condition, especially fluid intake, and balanced nutrition to support kidney function and fulfill daily activities.

Access to chronic kidney disease (CKD) care: Its barriers and facilitators in a community development block in Purba Bardhaman, West Bengal: A qualitative study.

Chronic kidney disease (CKD), a leading public health problem, has potential risks and serious implications on the health of individuals and society at large. Few studies explored the factors that influence access to CKD care at the community level in rural areas of West Bengal. A qualitative study was planned among key stakeholders to explore their views and experiences and to identify the barriers and potential facilitators that influence access to CKD care at the primary care level. Total 23 stakeholders participated in the study. Seventeen in-depth interviews (IDIs) were conducted on a purposive sample of stakeholders (CKD patients, healthcare providers (HCPs) and health planners) and one focus group discussion (FGD) among six community health workers. The audio-recorded interviews were transcribed verbatim. The Lévesque's framework for access to care as modified by Jodie Bailie et al. was employed to construct interview guides and structure the initial codes. Thematic analysis was undertaken using QSR NVivo version 11 using both inductive and deductive approaches. The major barriers to CKD care at patient level were poor knowledge and awareness of CKD and at the health system level was shortage of skilled staffs, diagnostics and medicines and fragmented referrals. The potential facilitators identified were educational activities to increase the awareness of CKD among HCPs and patients; provision of CKD-related supplies and a system-level approach to care coordination along with m-health-based care. Targeted CKD screening programs and CKD specific trainings may improve awareness of CKD. Additionally, stronger primary care infrastructure, availability of essential drugs and diagnostics and creating an efficient referral process for the quality CKD care are the need of the hour.

AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care.

Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.

Implementation Barriers of Multidisciplinary Care in Chronic Kidney Disease Through a CFIR Framework: a Narrative Review

Introduction 37 million Americans suffer from chronic kidney disease, which affects multiple organ systems and requires multidisciplinary care. Multidisciplinary care is an inherently broad and complex topic, and while it is being implemented across health care in the United States and abroad, multidisciplinary care outcomes are poor in this patient population. It is possible that there exist gaps in the literature regarding implementation and replication of multidisciplinary care interventions such that health care practices are unable to fully take advantage of multidisciplinary care publications for chronic kidney disease. This narrative review utilizes the five domains of the Consolidated Framework for Implementation Research to address barriers to multidisciplinary care implementation for chronic kidney disease. Methods A systematized review of peer-reviewed literature including systematic reviews and meta-analyses related to chronic kidney disease and multidisciplinary care through January 1, 2021 was conducted. The five interventions with the most barriers qualitatively identified were analyzed. Results Twelve potentially eligible reviews were identified, and 5 unique systematic reviews and meta-analyses were selected for a total of 48 articles, and ultimately, 5 articles were selected for inclusion. Based on the Consolidated Framework for Implementation Research which includes 5 domains of barriers, we discussed barriers of implementation in all 5 domains within the 5 articles. Discussion Because it is essential that multidisciplinary care for patients with chronic kidney disease be improved and implemented to the fullest extent, researchers should be aware of barriers to implementation and publish results by taking into account the Consolidated Framework for Implementation Research.

Food Insecurity and Chronic Kidney Disease: Considerations for Practitioners

The coronavirus disease 2019 pandemic has exacerbated existing health disparities related to food security status. Emerging literature suggests individuals with Chronic Kidney Disease (CKD) who are also food insecure have a greater likelihood of disease progression compared to food secure individuals. However, the complex relationship between CKD and food insecurity (FI) is understudied relative to other chronic conditions. The purpose of this practical application article is to summarize the recent literature on the social-economic, nutritional, to care through which FI may negatively impact health outcomes in individuals with CKD. While several studies have reported on the cross-sectional prevalence of FI among persons with CKD, literature is lacking about the severity and duration of exposure to FI on CKD outcomes. Future research is needed to better understand how FI impairs CKD care, nutritional and structural barriers that impact disease prevention and disease progression, and effective strategies to support patients.

#2695 THE ENVIRONMENTAL IMPACT OF CHRONIC KIDNEY DISEASE INTERNATIONALLY: RESULTS OF A LIFE CYCLE ASSESSMENT

Abstract Background and Aims The environmental impact of healthcare is high, and kidney care for chronic kidney disease (CKD) contributes significantly to this. Haemodialysis represents the only viable kidney replacement option for certain patients with CKD, in whom the clinical benefits are lifesaving. Haemodialysis is also resource-intensive, requiring frequent sessions, and energy- and water-intensive equipment. In recognition of this, the ERA has implemented a green nephrology initiative aiming to minimize the environmental impact of kidney care. However, there is a paucity of up-to-date analysis on the environmental impact of different dialysis techniques and CKD overall. This study presents an international, holistic life cycle assessment (LCA) of the environmental impact of CKD in adults at all CKD stages. Method LCA methodology was used, conducted according to ISO 14040/14044 international standards, to estimate the annual environmental impacts of each stage (1–5) of CKD per patient. At CKD Stage 5, supportive care, haemodialysis, peritoneal dialysis, and transplantation pathways were considered. A literature review was performed to identify all studies reporting healthcare resource use in CKD, stratified by CKD stage. The study boundary is summarised in Figure 1. GaBi software was used to model the pathway based on ecoinvent Life Cycle Inventory database version 3.8. Environmental impact categories were reported according to the impact assessment methods, ReCiPE 2016 v1.1 and TRACI 2.1 (US only). Here, we describe the preliminary analysis of the international study, presenting results on the annual environmental impact of in-centre haemodialysis in the UK, based on one patient receiving haemodialysis three times weekly for four hours per session. The inputs for in-centre haemodialysis comprised dialysis consumables and their transport, energy/water used by the haemodialysis machine (including reverse osmosis), heating/cooling/lighting of the healthcare area, waste disposal, and patient transport. Results A total of 93,600 litres of water and 3,058 kWh electricity was estimated per patient for in-centre haemodialysis annually in the UK. The carbon footprint of in-centre haemodialysis in the UK per patient was estimated to be 3,900 kg CO2 equivalents, comparable to the average UK persons annual greenhouse gas footprint, effectively doubling their yearly greenhouse gas impact. Several other environmental impact categories were measured beyond the carbon footprint, including photochemical oxidation potential (ground-level ozone formation) and fine particulate matter, measured as PM2.5. Across each impact category, the parameters that drove each environmental impact differed (Figure 2). For example, dialysis consumables, haemodialysis machine, and patient transport were the main environmental contributors of fine particulate matter, while patient transport was the main driver of terrestrial ecotoxicity. Conclusion The results of this LCA build upon previous published research and demonstrate a high carbon footprint for in-centre haemodialysis, in line with other studies. The results also show that the environmental impact of in-centre haemodialysis goes beyond that of its carbon footprint, to other important environmental aspects such as PM2.5 emissions, in which long-term exposure is associated with health problems, such as cardiovascular and respiratory diseases, and an increased risk of CKD. This study hopes to highlight the need for evidence-based policy interventions around the implementation of green nephrology initiatives such as use of renewable energy to power haemodialysis, utilisation of water conserving reverse osmosis systems, and reduction in waste. Furthermore, healthcare policy initiatives that could help detect patients in the early stages of CKD and thereby enable them to be managed proactively could eventually reduce the need for resource-intensive dialysis therapy.