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Reporting of 'dialysis adequacy' as an outcome in randomised trials conducted in adults on haemodialysis

Sanne Steyaert, Els Holvoet (UGent) , Evi Nagler (UGent) , Simon Malfait (UGent) and Wim Van Biesen (UGent)
(2019) PLOS ONE. 14(2).
Author
Organization
Abstract
Background : Clinical trials are most informative for evidence-based decision-making when they consistently measure and report outcomes of relevance to stakeholders, especially patients, clinicians, and policy makers. However, sometimes terminology used is interpreted differently by different stakeholders, which might lead to confusion during shared decision making. The construct dialysis adequacy is frequently used, suggesting it is an important outcome both for health care professionals as for patients. Objective : To assess the scope and consistency of the construct dialysis adequacy as reported in ran-domised controlled trials in hemodialysis, and evaluate whether these align to the insights and understanding of this construct by patients. Methods : To assess scope and consistency of dialysis adequacy by professionals, we performed a systematic review searching the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2017. We identified all randomised controlled trails (RCT) including patients on hemodialysis and reporting dialysis adequacy, adequacy or adequacy of dialysis and extracted and classified all reported outcomes. To explore interpretation and meaning of the construct of adequacy by patients, we conducted 11 semi-structured interviews with HD patients using thematic analysis. Belgian registration number B670201731001. Findings : From the 31 included trials, we extracted and classified 98 outcome measures defined by the authors as adequacy of dialysis, of which 94 (95%) were biochemical, 3 (3%) non-biochemical surrogate and 2 (2%) patient-relevant. The three most commonly reported measures were all biochemical. None of the studies defined adequacy of dialysis as a patient relevant outcome such as survival or quality of life. Patients had a substantially different understanding of the construct dialysis adequacy than the biochemical interpretation reported in the literature. Being alive, time spent while being on dialysis, fatigue and friendliness of staff were the most prominent themes that patients linked to the construct of dialysis adequacy. Conclusion : Adequacy of dialysis as reported in the literature refers to biochemical outcome measures, most of which are not related with patient relevant outcomes. For patients, adequate dialysis is a dialysis that enables them to spend as much quality time in their life as possible.
Keywords
QUALITY-OF-LIFE, CHRONIC KIDNEY-DISEASE, SINGLE-POOL KT/V, VARIABLE-VOLUME, UREMIC TOXINS, PROTEIN DIET, PATIENT, UREA, DIALYZERS, REMOVAL

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Chicago
Steyaert, Sanne, Els Holvoet, Evi Nagler, Simon Malfait, and Wim Van Biesen. 2019. “Reporting of ‘Dialysis Adequacy’ as an Outcome in Randomised Trials Conducted in Adults on Haemodialysis.” Plos One 14 (2).
APA
Steyaert, S., Holvoet, E., Nagler, E., Malfait, S., & Van Biesen, W. (2019). Reporting of “dialysis adequacy” as an outcome in randomised trials conducted in adults on haemodialysis. PLOS ONE, 14(2).
Vancouver
1.
Steyaert S, Holvoet E, Nagler E, Malfait S, Van Biesen W. Reporting of “dialysis adequacy” as an outcome in randomised trials conducted in adults on haemodialysis. PLOS ONE. 2019;14(2).
MLA
Steyaert, Sanne et al. “Reporting of ‘Dialysis Adequacy’ as an Outcome in Randomised Trials Conducted in Adults on Haemodialysis.” PLOS ONE 14.2 (2019): n. pag. Print.
@article{8609506,
  abstract     = {Background : Clinical trials are most informative for evidence-based decision-making when they consistently measure and report outcomes of relevance to stakeholders, especially patients, clinicians, and policy makers. However, sometimes terminology used is interpreted differently by different stakeholders, which might lead to confusion during shared decision making. The construct dialysis adequacy is frequently used, suggesting it is an important outcome both for health care professionals as for patients. 
Objective : To assess the scope and consistency of the construct dialysis adequacy as reported in ran-domised controlled trials in hemodialysis, and evaluate whether these align to the insights and understanding of this construct by patients. 
Methods : To assess scope and consistency of dialysis adequacy by professionals, we performed a systematic review searching the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2017. We identified all randomised controlled trails (RCT) including patients on hemodialysis and reporting dialysis adequacy, adequacy or adequacy of dialysis and extracted and classified all reported outcomes. To explore interpretation and meaning of the construct of adequacy by patients, we conducted 11 semi-structured interviews with HD patients using thematic analysis. Belgian registration number B670201731001. 
Findings : From the 31 included trials, we extracted and classified 98 outcome measures defined by the authors as adequacy of dialysis, of which 94 (95%) were biochemical, 3 (3%) non-biochemical surrogate and 2 (2%) patient-relevant. The three most commonly reported measures were all biochemical. None of the studies defined adequacy of dialysis as a patient relevant outcome such as survival or quality of life. Patients had a substantially different understanding of the construct dialysis adequacy than the biochemical interpretation reported in the literature. Being alive, time spent while being on dialysis, fatigue and friendliness of staff were the most prominent themes that patients linked to the construct of dialysis adequacy. 
Conclusion : Adequacy of dialysis as reported in the literature refers to biochemical outcome measures, most of which are not related with patient relevant outcomes. For patients, adequate dialysis is a dialysis that enables them to spend as much quality time in their life as possible.},
  articleno    = {e0207045},
  author       = {Steyaert, Sanne and Holvoet, Els and Nagler, Evi and Malfait, Simon and Van Biesen, Wim},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {QUALITY-OF-LIFE,CHRONIC KIDNEY-DISEASE,SINGLE-POOL KT/V,VARIABLE-VOLUME,UREMIC TOXINS,PROTEIN DIET,PATIENT,UREA,DIALYZERS,REMOVAL},
  language     = {eng},
  number       = {2},
  pages        = {20},
  title        = {Reporting of 'dialysis adequacy' as an outcome in randomised trials conducted in adults on haemodialysis},
  url          = {http://dx.doi.org/10.1371/journal.pone.0207045},
  volume       = {14},
  year         = {2019},
}

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