Understanding symptom treatment and management in people with chronic kidney disease

Open to UK applicants only

Supervisors:

• Professor James Burton jb343@leicester.ac.uk
• Dr Daniel March
• Dr Katherine Hull

Project Description:

People with chronic kidney disease (CKD) have a high symptom burden, with many reporting at least six, and some up to 20 different symptoms. Symptoms are often extremely debilitating, they negatively impact quality of life, and are associated with low treatment adherence, and mortality. Despite this, symptom recognition and management in CKD currently remains suboptimal (Zhu et al., 2023). Further to this, there appears a discordance between the prevalence of symptoms that are reported by people living with CKD, and the number that are estimated by healthcare professionals. The reasons for this discordance are multifactorial, although within clinical practice the assessment of symptoms such as CKD-aP are not routinely collected, which may play a role. Taken together, the result of this is that many people living with CKD are not offered treatment for these symptoms. One way in which symptom management may be improved for people living with CKD is through the regular reporting of symptoms; it has been previously recommended that this should be incorporated into usual clinical care (Davison et al., 2015). A method through which patient symptom burden can be captured is through the use of patient reported outcome measures (PROMS). PROMS are tools that use “any report of the status of a patient’s health condition that comes directly from the patient without interpretation by anyone else”. They are the outcomes that are the most important to patients and their families. However, within CKD care PROMS are not currently used, with several barriers limiting their implementation into healthcare systems. These include the patient and staff acceptance of PROMS, and the lack of integration into normal clinical workflow (Al Sayah et al., 2021). Therefore, there is a need to investigate current barriers to the regular use of PROMS, and investigate ways in which they can be implemented within clinical care.

In order to inform the work of the Guideline Groups, the candidate for this project will conduct two independent systematic reviews to understand (based on the latest available evidence) the most effective treatments for CKD-aP and fatigue in individuals with CKD. In addition, subsequent qualitative analysis of interviews and focus groups involving people with CKD and health-care professionals (to be convened by the candidate) will provide an understanding whether the routine use of PROMs is feasible and desirable within the current NHS and UK Renal Registry framework. Using PDSA methodology, we will then evaluate a structured approach to the use of PROMs (delivery, data collection, clinical utility, implementation) through the Leicester Renal Network. This will provide an understanding of the both the feasibility of such a project (to inform scalability) and clinical efficacy. Finally, we will then undertake a national survey (using Delphi methodology) to understand both current practice in symptom management in those with end-stage kidney disease and to create a national consensus document on the use of PROMs in clinical practice.

Please refer to the application advice below before submitting your online application.

References:
Al Sayah F, Jin X, Johnson JA. (2021). Selection of patient-reported outcome measures (PROMs) for use in health systems, Journal of Patient Reported Outcomes, 5(Suppl 2), 99

Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, Murtagh FE, Naicker S, Germain MJ, O-Donoghue DJ, Morton RL, Obrador GT. (2015). Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improve quality care, Kidney international, 88(3), 447-59

Zhu L, Li XL, Shi R , Wang DG. (2023). Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis, Renal Failure, 45(1); 2201361