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Transitioning From CKD to Kidney Failure: A Mixed-Methods Study of Patient Perspectives
Megan Urbanski1, Laura A Siminoff2, Amy Waterman3
1Department of Social and Behavioral Sciences; Division of Transplantation, Department of Surgery, Health Services Research Center, Emory University, Atlanta, Georgia; Emory University School of Medicine, Health Services Research Center, Emory University, Atlanta, Georgia.
Summary
The transition from chronic kidney disease (CKD) to kidney failure (KF) is tumultuous for all patients, regardless of prior nephrology care. Improving health system support is crucial for managing patient apprehension and fear during dialysis initiation.
Area of Science:
- Nephrology
- Patient Experience
- Healthcare Transition
Background:
- The progression from chronic kidney disease (CKD) to kidney failure (KF) necessitates dialysis, representing a significant life change for patients.
- Patient preparation and prior nephrology care vary widely, potentially influencing their experience during this critical transition.
Purpose of the Study:
- To explore the experiences of patients transitioning from CKD to KF and initiating dialysis.
- To compare these experiences based on the level of prior nephrology care and preparation received.
Main Methods:
- A convergent parallel mixed methods study involving surveys and interviews with 47 adult patients in Philadelphia.
- Participants were categorized based on prior nephrology care and dialysis access placement.
- Thematic analysis was applied to qualitative data, and quantitative data were described.
Main Results:
- All participants (N=47) found the KF transition tumultuous, irrespective of preparation level.
- Most patients (93.6%) initiated dialysis urgently in a hospital setting, primarily via in-center hemodialysis (97.9%).
- Key themes included patient unpreparedness for the KF diagnosis, chaotic communication environments, apprehension before the first dialysis, and the need to make sense of their new reality.
Conclusions:
- Patient apprehension and fear are common during the CKD to KF transition, even with prior preparation.
- Addressing health system-level factors is essential to improve patient experience and outcomes during this critical care transition.
- Future research should consider broader geographic representation and include non-English-speaking populations.
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