Transforming care and improving patient-important outcomes in people with kidney failure

Abstract

As patients transition from advanced chronic kidney disease (CKD) to dialysis and from one kidney replacement therapy (KRT) modality to another, they are often faced with higher levels of morbidity and mortality, resulting in further increases in healthcare costs and reductions in QoL. This thesis furthers our understanding of transition phases in the management of kidney failure treatment, and to identify opportunities to improve resource utilisation, support home-based therapies and reduce the burden on patients and the healthcare system. Chapter 2 of this thesis presents a perspective piece, examining the underlying causes of and downstream impacts of inequities in access to dialysis services in Australia and proposes tangible solutions to help address them. Chapter 3 of this thesis presents a mini review of the epidemiology and impact of symptoms in people with kidney failure, whilst also providing a framework on selecting appropriate symptom measures and evidence-based interventions for symptom assessment and management in the dialysis population. Chapter 4 examines incremental dialysis as a potential approach for people transitioning from advanced CKD to dialysis, exploring both potential benefits and harms. Chapter 5 examines the association between sex and all-cause and cause-specific PD discontinuation and explores the factors mediating this relationship. Chapter 6 evaluates how graft survival time affects home dialysis uptake and Chapter 7 examines how different kidney function trajectories prior to graft loss influence the time to home dialysis uptake. By examining factors affecting key transition phases in the management of kidney failure, this thesis provides a holistic foundation to inform future studies, clinical practice and policy aimed at transforming care and improving patient-important outcomes for people kidney failure.