The roads less traveled? Diverging research and clinical priorities for dialysis patients and those with less severe CKD

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Significant growth in long-term hemodialysis patients over four decades.
• Increasing age and comorbidities in dialysis patients, with limited treatments preventing adverse outcomes.
• Discrepancies exist between patient and physician priorities regarding treatment outcomes.
• Global rise in noncommunicable chronic diseases and chronic kidney disease (CKD), particularly in resource-limited settings.

Purpose of the Study:

• To address the divergence in clinical and research priorities between long-term dialysis patients and those with less severe CKD.
• To propose refocused clinical and research efforts for dialysis populations based on patient preferences.
• To highlight the need for innovative health service delivery for individuals with less severe CKD, especially in lower-income countries.

Main Methods:

• Review of trends in dialysis patient demographics and outcomes.
• Analysis of patient-physician perspectives on important health outcomes.
• Examination of global CKD prevalence and access to renal replacement therapies.
• Conceptual framework for aligning research and clinical priorities.

Main Results:

• Dialysis populations are aging with complex comorbid conditions.
• Current research often fails to address key patient-prioritized outcomes.
• Significant disparities in access to renal replacement therapies exist globally.
• Distinct approaches are needed for managing dialysis patients versus those with less severe CKD.

Conclusions:

• Future research and clinical practice must prioritize patient preferences in long-term dialysis care.
• Novel health service delivery models are crucial for managing the growing burden of CKD globally, particularly in underserved areas.
• A divergence in strategy is necessary for optimizing care across the CKD spectrum.