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@barnyhole.bsky.social

34 Followers  |  24 Following  |  14 Posts  |  Joined: 10.10.2024  |  1.8462

Latest posts by barnyhole.bsky.social on Bluesky

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How do older patients with advanced kidney disease, and their family members, understand kidney function and failure? A qualitative study - BMC Nephrology Background Patients approaching kidney failure are increasingly older, and living with multiple long-term conditions. The benefits of kidney replacement therapy (KRT) are uncertain for many in this gr...

doi.org/10.1186/s128...

Excellent paper led by Dr Charlotte Snead - we need to find ways of consulting with people about kidney disease that support them to make person-centred decisions.
@lucyselman.bsky.social @rachaelmorton.bsky.social @flissmurtagh.bsky.social @peolcsw.bsky.social

04.11.2025 13:45 — 👍 4    🔁 2    💬 1    📌 0

Pre #nephjc bias: Team pro protein

All these studies are deeply confounded and based in the pre-kidney-preserving therapy era.

Let them eat steak!

(Actually, let them eat vegetable sources of protein, but beans, lentils, and soy don’t rhyme with cake)

13.10.2025 15:43 — 👍 10    🔁 4    💬 2    📌 0

@europd.bsky.social EuroPD about to begin. Just finished at the pre-course course. Struck by how the home therapy wing of nephrology has person centred care central - in culture, guidance and practice. Looking forward to hearing that drum beaten over the next 48hrs!

08.10.2025 15:08 — 👍 5    🔁 1    💬 0    📌 0
Figure 1 | Patients have diverse preferences that reflect individual variation in what they consider important. Those planning for life with kidney failure want control over their futures and tend to desire autonomy in treatment decision-making. They will trade off the potential benefits of treatments against an over-riding desire to minimize disruption of daily and family life, responsibilities, and interests. The treatments that patients plan for and receive reflect complex processes involving many actors. Familial, community, societal, cultural, spiritual, clinical, and informational factors shape preferences, restrict or provide treatment options, and guide decisions. Skill, investment, and intentional practice are needed to ensure that patient preferences carry weight in decision-making.

Figure 1 | Patients have diverse preferences that reflect individual variation in what they consider important. Those planning for life with kidney failure want control over their futures and tend to desire autonomy in treatment decision-making. They will trade off the potential benefits of treatments against an over-riding desire to minimize disruption of daily and family life, responsibilities, and interests. The treatments that patients plan for and receive reflect complex processes involving many actors. Familial, community, societal, cultural, spiritual, clinical, and informational factors shape preferences, restrict or provide treatment options, and guide decisions. Skill, investment, and intentional practice are needed to ensure that patient preferences carry weight in decision-making.

Proud of this Kidney International paper: doi.org/10.1016/j.ki.... Nephrology involves optimal delivery of treatments that prolong life, preserve & replace organ function. The art lies in shaping this care to the person.
@rachaelmorton.bsky.social
@lucyselman.bsky.social
@flissmurtagh.bsky.social

19.08.2025 10:38 — 👍 6    🔁 5    💬 0    📌 0

Work led by @rakimmitt.bsky.social

15.07.2025 10:34 — 👍 1    🔁 0    💬 0    📌 0
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‘That’s why I wanted him to go on dialysis’ – a qualitative inductive thematic analysis of older patients’ and their family members’ perspectives on kidney failure treatment decision-making - BMC Neph... Background Chronic kidney disease (CKD) is increasingly common amongst frail older patients with multiple health problems. These patients typically decide between kidney replacement therapy (KRT) with...

📢 In BMJo: That’s why I wanted him to go on dialysis-a qualitative analysis of older patients’ & family members’ perspectives on kidney failure treatment rdcu.be/ewi4l
@lucyselman.bsky.social
@leilarooshenas.bsky.social
@peolcsw.bsky.social
@wolfsonpallcare.bsky.social
@flissmurtagh.bsky.social

15.07.2025 10:24 — 👍 6    🔁 5    💬 1    📌 0
IMPACT CKD – all roads must not lead to dialysis Version 2.0 March 31st 2025

www.kireports.org/article/S246... If all roads to lead to dialysis, the kidney failure population will experience unmet needs unseen for decades. @lucyselman.bsky.social @flissmurtagh.bsky.social @kidneycoalition.bsky.social @rcpdmeetings.bsky.social @kidneyint.bsky.social

16.06.2025 11:18 — 👍 5    🔁 4    💬 0    📌 0
‘It’s basically ‘have that or die’’: a qualitative study of older patients’ choices between dialysis and conservative kidney management Objectives Older people with kidney failure often have a limited range of treatment options, with few being well enough to receive a transplant. Instead, they either start dialysis or have ‘conservative kidney management’ (CKM). CKM involves care that focuses on managing the symptoms of kidney failure and maintaining quality of life in the absence of dialysis. The relative ability of dialysis and CKM to make older people live longer and feel better is uncertain. This study aimed to describe how older patients understand and decide between dialysis and CKM, as evidence suggests they may not be fully supported to make informed decisions between these treatments. Design Qualitative study using semistructured interviews, analysed using inductive thematic analysis and constant comparative techniques. Setting Three UK specialist kidney units. Participants Adults with estimated glomerular filtration rate (eGFR) <20 and aged over 80 years, irrespective of comorbidity or over 65 if living with two additional long-term conditions or frailty. Participants were purposively sampled to maximise clinicodemographic variation, and recruitment was continued until no new major themes were arising in the analysis. Results Eight men and seven women with a median age of 81 (range 65–90), and a median eGFR of 12 were interviewed. Three themes were identified: (1) ‘Do dialysis or die’, where not having dialysis was equated with death; (2) The ‘need’ for dialysis, where haemodialysis was perceived as the default treatment and (3) Weighing-up quality and quantity of life, relating to the trade-offs made between treatment benefits and burdens. Participants appeared unlikely to recognise the uncertain survival benefits of dialysis. Our study took place in England and all the participants were white British. As culture and faith can play a large part in decisions involving life and death, our findings may not be applicable to those in other communities. Participants were recruited from three centres, limiting the breadth of approaches to kidney failure management. Conclusions For older people who face short lives irrespective of treatment for kidney failure, unfamiliarity with treatment options, the desire to live and the ‘do or die’ notion conspire to cast haemodialysis as inevitable, regardless of whether this is the most appropriate treatment. To best enable shared decision-making, clinicians should present kidney failure treatment options in an accurate and balanced way, and respect and support older people who are deciding whether to have CKM or dialysis. This includes articulating uncertainty and supporting patients to make trade-offs in relation to what is important to them. Data are available on reasonable request. Participants consented to their anonymised data being made available to other researchers who want to analyse the data in the future. Data are managed by the University of Bristol and applications for their use should be made to the communicating author.

PS if you liked this, you may also be interested in doi.org/10.1136/bmjo...

10.03.2025 15:30 — 👍 1    🔁 0    💬 0    📌 0

PS if you liked this, you may also be interested in t.co/B5fTbmQu00

10.03.2025 15:29 — 👍 2    🔁 1    💬 0    📌 0

Thanks Lucy! Please read: our findings suggest that we have made little progress in helping older, frailer and comorbid people understand the true trade offs between preparing for dialysis and conservative management. We need to do better and suggest some approaches that might help.

10.03.2025 09:45 — 👍 3    🔁 2    💬 1    📌 0
Post image Post image Post image

📢 New paper in BMJ Open, led by @barnyhole.bsky.social.
‘It’s basically ‘have that or die’’: a qualitative study of older patients’ choices between dialysis and conservative kidney management
@leilarooshenas.bsky.social
@peolcsw.bsky.social
@wolfsonpallcare.bsky.social
@flissmurtagh.bsky.social

10.03.2025 08:19 — 👍 18    🔁 7    💬 2    📌 1

Finally made time to read this in full. Such important work. 1) may explain the gap between what clinicians report they said and what patients report hearing and 2) why wasn't this snapped up by our biggest journals?! More practice-informing than most of what is published.

10.12.2024 18:54 — 👍 1    🔁 0    💬 0    📌 0
Redirecting

The paper is now all neatly typeset with author corrections and ***OPEN ACCESS*** here: kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...

01.11.2024 12:16 — 👍 3    🔁 1    💬 0    📌 0

...3/3 but the devil is in the detail: Some need much more, some would only accept care at home, others in hospital, and some appeared to need no benefit to independence or survival to accept dialysis. More work needed to ensure people are supported to make these hard choices.

10.10.2024 08:04 — 👍 5    🔁 0    💬 1    📌 0

Overall, older people facing kidney failure needed an average 13% absolute survival benefit at two years (maybe equivalent to a year's life extension) to tolerate three hospital dialysis sessions a week... 2/3

10.10.2024 08:04 — 👍 2    🔁 0    💬 1    📌 0
DEFINE_ME

I hear academics are over here! This is out: A choice experiment of older patients’ preferences for kidney failure treatments. www.kidney-international.org/article/S008... @lucyselman.bsky.social (1/3)

10.10.2024 08:03 — 👍 9    🔁 4    💬 2    📌 0

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