Improving Outcome of Dialysis Patients in the Initiation Phase Open Access

Jabi, Rania (Spring 2019)

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Purpose:The purpose of this thesis was to refine general public health and practitioner knowledge regarding interventions that would improve dialysis patient outcomes including patient survival and quality of life. Patient morbidity and mortality could be reduced by systematically identifying measures that might improve dialysis outcomes. A systematic literature review would help reveal and evolve practices in this area. 

Methods:This thesis utilized a systematic literature review with relevant articles and analyzed the data available to address the question of how to improve outcome of dialysis patients in the first year of dialysis treatment. The first year of dialysis is usually associated with high mortality, morbidity and healthcare cost. The systematic literature review produced ten peer reviewed studies for analysis. The common outcome variables in all studies were identified and compared. 

Results:All of the selected studies contained important conclusions regarding the importance of vascular access type, arteriovenous fistula (AVF) and its benefits to improve patient outcome. Improving vascular access for incident hemodialysis patients was very important. This could be achieved by increasing the percentage of hemodialysis patients who use AVF as the primary mode of vascular access at the start of treatment.

Conclusions:Public Health and practitioner education is needed to increase the knowledge regarding the benefits of early referral of patients with advanced chronic kidney disease to nephrologist. This was also essential to improve outcome by providing better dialysis preparation and early placement of AVF. Providing structured programs for prompt educational and medical strategies in early end stage renal disease patients was promising and had potential benefits. Standardization of research data is needed as is additional research specifically including cost data.       

Table of Contents

Table of Contents

Chapter 1: Introduction       1

Introduction and Rationale     1

Problem Statement     2

US Experience Poor   2

High U. S. Mortality Rates     4

Comparisons of Dialysis Methods & Outcomes Needed       5

Systematic Analysis Needed  7

Purpose Statement      9

Systematic Review     10

Significance Statement           11

Chapter 2: Review of literature      13

Introduction    13

Body of Review of Literature             13

Chronic Kidney Disease and end-stage renal disease            13

Importance of United States Renal Data System (USRDS)   14

Renal Replacement Options   15

Geographic Distribution in USA        15

Mortality         16

Vascular Access         17

Hospitalization            18

Health care cost          19

International Comparison       20

Summary of Current Problem and Study Relevance 21

Chapter 3: Methodology      24

Introduction    24

Literature Search Methodology          25

Eligibility Criteria      26

Inclusion/Exclusion Criteria   26

Data Extraction and quality assurance           28

Analysis Review         30

Chapter 4: Results    31

Introduction    31

Study Characteristics        31

Tables/figures that support analysis               32

Analysis of major themes and findings          34

Variables that were common to the studies    34

Variables that were missing from the studies     38

Results Summary        39

Chapter 5: Discussion          41

Introduction    41

Summary of key study findings          41

Limitations      41

Implications    42

Implications for General Public Health and Practitioner Practice     42

Implications for public health practice           42

Recommendations      43

General Public Health Education       43

Clinician Education    43

Patient Education        44

Enhancements to informatics (Electronic Health Records)   44

Recommendations for clinical practice          46

Recommendations for future research            48

Conclusion      48

References     50

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