Timing of patient-reported renal replacement therapy planning discussions by disease severity among children and young a
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ORIGINAL ARTICLE
Timing of patient-reported renal replacement therapy planning discussions by disease severity among children and young adults with chronic kidney disease Derek K. Ng 1 & Yunwen Xu 1 & Julien Hogan 2 & Jeffrey M. Saland 3 & Larry A. Greenbaum 4 & Susan L. Furth 5 & Bradley A. Warady 6 & Craig S. Wong 7 Received: 24 October 2019 / Revised: 27 February 2020 / Accepted: 18 March 2020 # IPNA 2020
Abstract Background Preparing children with chronic kidney disease (CKD) for renal replacement therapy (RRT) begins with a discussion about transplant and dialysis, but its typical timing in the course of CKD management is unclear. We aimed to describe participant-reported RRT planning discussions by CKD stage, clinical and sociodemographic characteristics, in the Chronic Kidney Disease in Children (CKiD) cohort. Methods Participants responded to the question “In the past year, have you discussed renal replacement therapy with your doctor or healthcare provider?” at annual study visits. Responses were linked to the previous year CKD risk stage based on GFR and proteinuria. Repeated measure logistic models estimated the proportion discussing RRT by stage, with modification by sex, age, race, socioeconomic status, and CKD diagnosis (glomerular vs. non-glomerular). Results A total of 721 CKiD participants (median age = 12, 62% boys) contributed 2856 person-visits. Proportions of personvisits reporting RRT discussions increased as CKD severity increased (10% at the lowest disease stage and 87% at the highest disease stage). After controlling for CKD risk stage, rates of RRT discussions did not differ by sex, age, race, and socioeconomic status. Conclusions Despite participant-reported RRT discussions being strongly associated with CKD severity, a substantial proportion with advanced CKD reported no discussion. While recall bias may lead to underreporting, it is still meaningful that some participants with severe CKD did not report or remember discussing RRT. Initiating RRT discussions early in the CKD course should be encouraged to foster comprehensive preparation and to align RRT selection for optimal health and patient preferences. Keywords Renal replacement therapy . Chronic kidney disease . End-stage kidney disease . Transplant
Introduction The preparation for renal replacement therapy (RRT) is a necessary part of managing pediatric chronic kidney disease
(CKD) as it progresses to end-stage kidney disease (ESKD). Kidney transplant is the preferred treatment modality for pediatric ESKD, but dialysis is common when organs are not available or if transplant is temporarily contraindicated [1].
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04542-2) contains supplementary material, which is available to authorized users. * Derek K. Ng [email protected] 1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
2
Emory Transplant Center, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA
3
Department of
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