Background
Chronic kidney disease prevalence is increasing globally. Those with end-stage kidney disease may require hemodialysis, a complex and costly treatment modality, which is associated with many challenges.
Objectives
This thesis focuses on four objectives, each addressing a different challenge in research among chronic kidney disease patients on hemodialysis: (1) examining dietary mobile app intervention feasibility and effectiveness in changing user behavior; (2) analyzing the impact of arteriovenous access type and risk of maturation failure on the total costs of attaining and maintaining patency of arteriovenous access over one, three, and five years post creation; (3) determining the feasibility of conducting a randomized controlled trial to evaluate the impact of a novel catheter care protocol on the rate of catheter-related bacteremia; and (4) evaluating the completeness of reporting in pilot randomized controlled trials.
Methods
Study 1: A systematic review was conducted, which included a search of scholarly databases, as well as the gray literature, for all randomized controlled trials, observational studies, needs assessments, and pilot testing/studies/trials focused on the development or evaluation of chronic kidney disease dietary mobile app interventions. The characteristics, user satisfaction with, usability/feasibility, and effectiveness in changing dietary behavior of the mobile application were summarized using descriptive statistics and in a narrative manner.
Study 2: A cost analysis was conducted in which all first arteriovenous access creations (January 1, 2002 – January 1, 2018), revisions, removals, and interventions from a single academic institution were prospectively captured. The present value of total vascular access related costs from a third-party payer perspective was calculated and the potential associations of arteriovenous access type and risk of Failure to Mature stratum with arteriovenous access cost were examined using Loglinear models and generalized estimating equations.
Study 3: A pilot randomized trial was conducted in which adult hemodialysis patients using catheters were recruited from 11 hemodialysis units. Patients were randomized to receive Hemodialysis Infection Prevention Protocols Ontario—Shower Technique or standard care and were followed up for 6 months. Only catheter related bacteremia outcome assessors were blinded. For the study to be considered feasible, 4 of 5 feasibility outcomes, each with its own statistical threshold for success, must have been achieved.
Study 4: A methodological survey was conducted of Pubmed for all pilot trials conducted in HD patients. Reporting quality was assessed against the 40-item Consolidated Standards of Reporting Trials (CONSORT) Extension for Pilot Trials. Potential associations between study factors including year and country of publication, intervention, number of centers, type of funding, and journal endorsement of CONSORT with reporting quality were also examined.
Results and conclusions
Study 1: Thirteen full-text studies were included: of the 7 pilot studies that measured usability/feasibility, all found at least some aspects of the application feasible/useful and of the 5 pilot studies that reported an evaluation of changes in behavior/diet related to self-management, all reported some positive change. According to current studies, nutritional apps show promise in chronic kidney disease self-management.
Study 2: A total of 906 patients were included in the study, 696 fistulas and 210 grafts.
The costs of attaining and maintaining arteriovenous access were increased among patients with high/very high risk of Failure to Mature.
Study 3: A total of 68 patients were randomized (33 shower technique and 35 control) and were followed up to 6 months. Of 5 measures of feasibility, 4 were achieved. The pilot study demonstrated the feasibility of the larger study, especially given the high levels of education success with the shower technique arm and the low levels of contamination in the control arm.
Study 4: The mean number of items reported from the CONSORT extension for pilot trials across all included articles was 18.4 (standard deviation [SD] = 4.4). In the adjusted analysis, studies reported in later years (incidence rate ratio [IRR] = 1.026, 95% confidence interval [CI] [1.018, 1.034], p < 0.001) and an increase of 20 persons in sample size (adjusted IRR = 1.021, 95% CI [1.010, 1.031], p < 0.001) were associated with a significantly higher number of CONSORT pilot items reported. Current reporting completeness of pilot trials in hemodialysis patients is suboptimal. / Thesis / Candidate in Philosophy
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/25347 |
| Date | January 2020 |
| Creators | Kosa, Sarah Daisy |
| Contributors | Thabane, Lehana, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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