نبذة مختصرة : For patients with chronic kidney disease (CKD) who develop kidney failure, renal replacement therapy (RRT) with kidney transplantation is the best treatment option. But if this is not possible due to lack of organs or medical factors, dialysis initiation with haemodialysis (HD) or peritoneal dialysis (PD) is required. Unplanned start (UPS) of dialysis using in-centre HD with central venous catheter (CVC) as default option is common and associates with increased mortality and lower chance of receiving PD. Educating and providing PD to UPS patients is possible and with clinical outcomes comparable to UPS with HD. As RRT patients have increased cardiovascular disease (CVD) related mortality - due to not only traditional risk factors but also non-traditional risk factors such as inflammation, oxidative stress, endothelial dysfunction and protein energy wasting – there is a need to identify biomarkers reflecting such risk factors. This thesis consists of three studies aimed to improve the knowledge about patient education in conjunction with dialysis initiation and in particular the effect of the unplanned education programme (UPS-EP) on clinical outcomes of UPS patients, and two studies of the predictive role of two putative clinically useful biomarkers (S100A12 and pentosidine) which are components of AGE-RAGE pathway. In Study I we evaluated the feasibility and impact of UPS-EP to allow modality choice in 270 patients. Patients completing UPS-EP were more likely to select PD as their preferred modality. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD patients. In Study II, factors influencing three key steps in the UPS patient educational pathway: (1) referral to and receiving UPS-EP, (2) making decision on dialysis modality, (3) receiving preferred dialysis modality after decision making were analyzed. Older age reduced probability of receiving UPS-EP but not the chance of making modality decision. Cultural country factors had strong ...
Relation: I. Machowska A, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul Rashid Qureshi, Bengt Lindholm and Peter Rutherford. Offering Patients Therapy Options in Unplanned Start (OPTiONS): implementation of an educational program is feasible and effective. [Submitted]; II. Machowska A, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul Rashid Qureshi, Bengt Lindholm and Peter Rutherford. Factors influencing access to education, decision making and receiving preferred dialysis modality in unplanned start dialysis patients. Patient Preference and Adherence. 2016:10 2229–2237. ::doi::10.2147/PPA.S119243; III. Machowska A, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul Rashid Qureshi, Bengt Lindholm and Peter Rutherford. Dialysis access, infections and hospitalizations in unplanned dialysis start patients - results from the OPTiONS study. [Manuscript]; IV. Isoyama N, Machowska A, Qureshi AR, Yamamoto T, Anderstam B, Heimburger O, Barany P, Stenvinkel P, Lindholm B. Elevated circulating S100A12 associates with vascular disease and worse clinical outcome in peritoneal dialysis patients. Perit Dial Int. 2016 5-6;36(3):269-276. ::doi::10.3747/pdi.2014.00121 ::pmid::26493750 ::isi::000376576400007; V. Machowska A, Jia Sun, Abdul Rashid Qureshi, Naohito Isoyama, Paul Leurs, Björn Anderstam, Olof Heimburger, Peter Barany, Peter Stenvinkel and Bengt Lindholm. Plasma pentosidine and its association with mortality in patients with chronic kidney disease. PLoS One. 2016 Oct 4;11(10):e0163826. ::doi::10.1371/journal.pone.0163826 ::pmid::27701453; http://hdl.handle.net/10616/45365
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