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Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access.

Publication ,  Journal Article
Grubbs, V; Jaar, BG; Cavanaugh, KL; Ephraim, PL; Ameling, JM; Cook, C; Greer, RC; Boulware, LE
Published in: BMC Nephrol
February 16, 2021

BACKGROUND: While catheters are often thought the result of emergency hemodialysis (HD) initiation among patients with little or no pre-dialysis nephrology care, the role of patient level of engagement in care and modality decision-making have not been fully explored. METHODS: This is a retrospective medical record review of adults (age 18-89 years) who received care in academically affiliated private practice, public hospital, or Veterans Administration settings prior to initiating HD with a catheter between 10/1/2011 and 9/30/2012. Primary predictors were level of patient engagement in nephrology care within 6 months of HD initiation and timing of modality decision-making. Primary outcomes were provider action (referral) and any patient action (evaluation by a vascular surgeon, vein mapping or vascular surgery) toward [arteriovenous fistula or graft, (AVF/AVG)] creation. RESULTS: Among 92 incident HD patients, 66% (n = 61) initiated HD via catheter, of whom 34% (n = 21) had ideal engagement in care but 42% (n = 25) had no documented decision. Providers referred 48% (n = 29) of patients for AVF/AVG, of whom 72% (n = 21) took any action. Ideal engagement in care predicted provider action (adjusted OR 13.7 [95% CI 1.08, 175.1], p = 0.04), but no level of engagement in care predicted patient action (p > 0.3). Compared to patients with no documented decision, those with documented decisions within 3, 3-12, or more than 12 months before initiating dialysis were more likely to have provider action toward AVF/AVG (adjusted OR [95% CI]: 9.0 [1.4,55.6], p = 0.2, 37.6 [3.3423.4] p = 0.003, and 4.8 [0.8, 30.6], p = 0.1, respectively); and patient action (adjusted OR [95% CI]: 18.7 [2.3, 149.0], p = 0.006, 20.4 [2.6, 160.0], p = 0.004, and 6.2 [0.9, 44.0], p = 0.07, respectively). CONCLUSIONS: Timing of patient modality decision-making, but not level of engagement in pre-dialysis nephrology care, was predictive of patient and provider action toward AVF/AVG Interventions addressing patients' psychological preparation for dialysis are needed.

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Published In

BMC Nephrol

DOI

EISSN

1471-2369

Publication Date

February 16, 2021

Volume

22

Issue

1

Start / End Page

60

Location

England

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Retrospective Studies
  • Renal Dialysis
  • Patient Participation
  • Nephrology
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
 

Citation

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Chicago
ICMJE
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Grubbs, V., Jaar, B. G., Cavanaugh, K. L., Ephraim, P. L., Ameling, J. M., Cook, C., … Boulware, L. E. (2021). Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access. BMC Nephrol, 22(1), 60. https://doi.org/10.1186/s12882-021-02264-7
Grubbs, Vanessa, Bernard G. Jaar, Kerri L. Cavanaugh, Patti L. Ephraim, Jessica M. Ameling, Courtney Cook, Raquel C. Greer, and L Ebony Boulware. “Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access.BMC Nephrol 22, no. 1 (February 16, 2021): 60. https://doi.org/10.1186/s12882-021-02264-7.
Grubbs V, Jaar BG, Cavanaugh KL, Ephraim PL, Ameling JM, Cook C, et al. Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access. BMC Nephrol. 2021 Feb 16;22(1):60.
Grubbs, Vanessa, et al. “Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access.BMC Nephrol, vol. 22, no. 1, Feb. 2021, p. 60. Pubmed, doi:10.1186/s12882-021-02264-7.
Grubbs V, Jaar BG, Cavanaugh KL, Ephraim PL, Ameling JM, Cook C, Greer RC, Boulware LE. Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access. BMC Nephrol. 2021 Feb 16;22(1):60.
Journal cover image

Published In

BMC Nephrol

DOI

EISSN

1471-2369

Publication Date

February 16, 2021

Volume

22

Issue

1

Start / End Page

60

Location

England

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Retrospective Studies
  • Renal Dialysis
  • Patient Participation
  • Nephrology
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans