Evidence map›Paper›PMID 35243306›Full record

ArticleKidney medicine2022

African Americans' Hemodialysis Treatment Adherence Data Assessment and Presentation: A Precision-Based Paradigm Shift to Support Quality Improvement Activities.

Ebele M Umeukeje, Deklerk Ngankam, Lauren B Beach, Jennifer Morse, Heather L Prigmore, Thomas G Stewart, Julia B Lewis, Kerri L Cavanaugh

Abstract read
In one paragraph

Article in Kidney medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ebele M UmeukejeDivision of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.
Deklerk NgankamDepartment of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Lauren B BeachDepartment of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, Illinois.
Jennifer MorseDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Heather L PrigmoreDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Thomas G StewartDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Julia B LewisDivision of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.
Kerri L CavanaughDivision of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.

Funding

Research Design, Data, and Analytics CoreP30DK092949 · NIDDK · UNIVERSITY OF CHICAGO · PI MILDA Renne SAUNDERS · 2011 to 2026
$10.0M
Determining Key Organizational Health Communication Practices in Complex PatientsR01DK103935 · NIDDK · VANDERBILT UNIVERSITY MEDICAL CENTER · PI CAVANAUGH, KERRI · 2015 to 2019
$2.0M
Patient-centered Approach To Improving Dialysis Adherence in African AmericansK23DK114566 · NIDDK · VANDERBILT UNIVERSITY MEDICAL CENTER · PI UMEUKEJE, EBELE M · 2018 to 2022
$929k
MOVE: MOtiVational Strategies To Empower African Americans To Improve Dialysis AdherenceR03DK129626 · NIDDK · VANDERBILT UNIVERSITY MEDICAL CENTER · PI UMEUKEJE, EBELE M · 2021 to 2022
$260k
NIDDK NIH HHS K23 DK114566NIDDK NIH HHS P30 DK092949NIDDK NIH HHS R01 DK103935NIDDK NIH HHS R03 DK129626
6 · The paper itself

Abstract

RATIONALE &

objectiveThrice-weekly hemodialysis can result in adequate urea clearance; however, the morbidity and mortality rates of patients treated with maintenance dialysis remain unacceptably high, partly because of nonadherence. African Americans have a higher prevalence of kidney failure treated with dialysis, greater dialysis nonadherence, and higher odds of hospitalization. We hypothesized that more precise ways of assessing dialysis treatment adherence will reflect the severity of nonadherence, distinguish patterns of nonadherence, and inform the design of personalized behavioral interventions. STUDY

designRetrospective cohort study. SETTING &

participantsAfrican American patients receiving hemodialysis for >90 days. EXPOSURE: Hemodialysis. OUTCOME: Dialysis adherence. ANALYTICAL APPROACH: Dialysis attendance data were displayed using a dot plot, categorized based on missed and shortened treatments, and examined for patterns. Descriptive characteristics were reported. In an exploratory analysis, associations between dialysis treatment adherence and participant characteristics were evaluated using ordinary least squares regression. An analysis was performed using missed minutes of dialysis and current metrics for measuring dialysis treatment adherence (ie, missed and shortened treatments).

resultsAmong 113 African American patients treated with dialysis, 47% were men; the median age was 57 years (interquartile range, 46-70 years), and the median dialysis vintage was 54 months (interquartile range, 22-90 months). With rows ordered based on the total missed minutes of dialysis, the dot plot displayed a decreasing gradient in the severity of nonadherence, with novel dialysis treatment adherence categories termed as follows: consistent underdialysis, inconsistent dialysis, and consistent dialysis. Distinct patterns of nonadherence and heterogeneity emerged within these categories. Older age was consistently associated with better adherence, as determined by the analyses performed using the total missed minutes of dialysis as well as missed and shortened treatments. LIMITATIONS: The study findings, although replicable and paradigm-shifting, might be limited by the short timeline, focus on adherence data specific to African American patients treated with dialysis, and restriction to dialysis units affiliated with 1 academic center.

conclusionsThis study presents more precise and novel ways of measuring and displaying dialysis treatment adherence. The findings introduce a more personalized approach for evaluating actual dialysis uptake. Identification of unique patterns of adherence behavior is important to inform the design of effective behavioral interventions and improve outcomes for vulnerable African American patients treated with dialysis.

Indexed as

AdherenceAfrican Americansdialysisend-stage kidney diseasehemodialysis

Identifiers

PMID35243306
PMCPMC8861945

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.