Browsing by Author "MacRae, Jennifer M."

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    Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients
    (BioMed Central, 2011-09-26) Thomson, Benjamin K. A.; MacRae, Jennifer M.; Barnieh, Lianne; Zhang, Jianguo; MacKay, Elizabeth; Manning, Megan A.; Hemmelgarn, Brenda R.
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    Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas
    (2024-05-08) Ghimire, Anukul; Shah, Samveg; Chauhan, Utkarsh; Ibrahim, Kwaifa S.; Jindal, Kailash; Kazancioglu, Rumeyza; Luyckx, Valerie A.; MacRae, Jennifer M.; Olanrewaju, Timothy O.; Quinn, Robert R.; Ravani, Pietro; Shah, Nikhil; Thompson, Stephanie; Tungsanga, Somkanya; Vachharanjani, Tushar; Arruebo, Silvia; Caskey, Fergus J.; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Malik, Charu; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G.; Bello, Aminu K.; Johnson, David W.
    Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
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    Health related quality of life during dialysis modality transitions: a qualitative study
    (2023-09-22) Dumaine, Chance S.; Fox, Danielle E.; Ravani, Pietro; Santana, Maria J.; MacRae, Jennifer M.
    Abstract Background Modality transitions represent a period of significant change that can impact health related quality of life (HRQoL). We explored the HRQoL of adults transitioning to new or different dialysis modalities. Methods We recruited eligible adults (≥ 18) transitioning to dialysis from pre-dialysis or undertaking a dialysis modality change between July and September 2017. Nineteen participants (9 incident and 10 prevalent dialysis patients) completed the KDQOL-36 survey at time of transition and three months later. Fifteen participants undertook a semi-structured interview at three months. Qualitative data were thematically analyzed. Results Four themes and five sub-themes were identified: adapting to new circumstances (tackling change, accepting change), adjusting together, trading off, and challenges of chronicity (the impact of dialysis, living with a complex disease, planning with uncertainty). From the first day of dialysis treatment to the third month on a new dialysis therapy, all five HRQoL domains from the KDQOL-36 (symptoms, effects, burden, overall PCS, and overall MCS) improved in our sample (i.e., those who remained on the modality). Conclusions Dialysis transitions negatively impact the HRQoL of people with kidney disease in various ways. Future work should focus on how to best support people during this time.
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    Pneumatic compression devices during hemodialysis
    (2012-08-28) Tai, Davina Julia; Ahmed, Sofia B.; MacRae, Jennifer M.
    Hemodynamic stability during hemodialysis requires maintenance of central blood volume (CBV), which pneumatic compression devices (PCDs) may help preserve. We performed a randomized crossover trial to determine the effect of PCDs on CBV during hemodialysis. Fifty-one patients were randomized to begin the first of two hemodialysis sessions with or without PCDs. The median change in CBV for PCDs vs control was -0.08 vs -0.05L (p=0.62). There was no difference in change in cardiac output (-0.63 vs -0.49L/min, p=0.78) or systemic vascular resistance (+1.30 vs +1.55mmHg/L/min, p=0.67) for PCDs vs control. There was a greater reduction in total body water (-2.6 vs -2.3L, p=0.05) and intracellular fluid volume (-1.3 vs -1.1L, p=0.03), with no difference in extracellular fluid volume (-1.3 vs -1.2L, p=0.09) for PCDs vs control. Compared with standard of care, PCDs have no effect on intradialytic hemodynamic parameters, including CBV, although they may allow greater capacity for fluid removal.