At the end of 2014, 20,690 Canadians were receiving chronic dialysis. Unfortunately, many of these patients started dialysis sub-optimally. There are various definitions for a sub-optimal dialysis start, but most include the criteria of dialysis initiation during a hospitalization and/or with a central venous catheter (CVC).
Patients with a sub-optimal dialysis start have increased morbidity and mortality. As well, patients who start dialysis without appropriate preparation have likely been denied the opportunity to make an informed decision with respect to their end stage renal disease (ESRD) care.
There is also the important consideration of cost. It is estimated that preventing one sub-optimal dialysis start could save the Canadian Healthcare System $20,275 in hospital costs.The first step towards reducing the incidence of sub-optimal dialysis initiation is to identify important risk factors.
Our study will be the first to prospectively examine actionable and modifiable risk factors for sub-optimal dialysis initiation among patients with advanced chronic kidney disease (CKD) followed in multi-care kidney clinics (MCKC). MCKCs are multi-disciplinary clinics wherein patients are prepared for renal replacement therapy (RRT).
We are investigating if reduced health literacy (HL) is associated with an increased risk of hospitalizations, medication non-adherence, and patient related delayed decision-making with respect to RRT preparation, and determining patient perspectives regarding RRT preparation.
The results will help inform the design of a multi-faceted intervention to be tested in a cluster randomized clinical trial with the ultimate aim of reducing the incidence of sub-optimal dialysis starts.Download Presentation PDF
Prospective observational study
Amber Molnar is a nephrologist at St. Joseph’s Healthcare in Hamilton, and Assistant Professor, Department of Medicine, Division of Nephrology, McMaster University. Her research program focuses on improving the pre-dialysis care of patients with advanced chronic kidney disease (CKD) and reducing cardiovascular complications in patients with CKD.
She holds a Kidney Research Scientist Core Education and National Training (KRESCENT) program’s New Investigator Award through CIHR and the Kidney Foundation of Canada. Amber earned her M.D. at the University of Saskatchewan followed by internal medicine training at Western University, and completed her nephrology and MSc (Epidemiology) training at the University of Ottawa.
Michael Walsh is a Principal Investigator in the Renal research program at PHRI, and an Assistant Professor, Department of Medicine (nephrology), McMaster University. His research activities are in the areas of the treatment of patients who require dialysis, severe glomerular disease, and perioperative acute kidney injury. He has published more than 70 papers and two book chapters.
He holds a Kidney Research Scientist Core Education and National Training (KRESCENT) Program New Investigator award through CIHR and the Kidney Foundation of Canada. He’s received multiple Top Abstract awards from the Canadian Society of Nephrology, the Chalmers Prize from the Society for Clinical Trials, and the Detweiller Traveling Scholar Award from the College of Physicians and Surgeons of Canada.
Tara McCready, PhD, oversees a variety of collaborative programs at PHRI, and serves as Project Manager for PHRI research studies and registries.
She was recruited to PHRI as a Program Director for the Canadian Network and Centre for Trials Internationally (CANNeCTIN), a national network funded by the CIHR/CFI Clinical Research Initiative program to improve the prevention and treatment of cardiac and vascular diseases and diabetes.
Previously the Executive Director of the Canadian Maternal, Infant, Child and Youth Research Network, Tara holds a PhD in Biochemistry and a MBA in Technology Commercialization from the University of Alberta.
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