Edwina Brown

Edwina Brown
Imperial College Healthcare NHS Trust · Renal

DM (Oxon), FRCP

About

287
Publications
30,278
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
8,321
Citations

Publications

Publications (287)
Article
We have developed a supportive two-exchange assisted continuous ambulatory peritoneal dialysis (asCAPD) programme for the older frail person who cannot do autonomous PD and do not want or are considered to be too high risk for haemodialysis (HD). Evaluation of the programme was determined by data collected retrospectively from patient records. Prim...
Article
Introduction Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrolog...
Preprint
Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment may partially explain the differences in outcomes observed. The Ki...
Article
Full-text available
Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the COVID-19 pandemic. Peritoneal Dialysis (PD) is the more commonly used home therapy option. This paper provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting tim...
Chapter
End-stage kidney disease (ESKD) is a chronic medical condition with a significant symptom burden. Treatment with kidney replacement therapies, including peritoneal dialysis (PD), can improve survival and ameliorate the complications and consequences of ESKD but do not provide a ‘cure’. For many patients, some of whom may be on dialysis for life, th...
Article
Peritonitis is one of the major risks of peritoneal dialysis (PD) causing significant morbidity and in some instances, mortality. It is one of the principal causes of transfer to hemodialysis (HD). Peritonitis rates should be audited by units. The recommended rate by the ISPD is less than 0.5 episodes/year
Article
Rationale & Objective Individuals faced with decisions regarding kidney replacement therapy options need information on how dialysis treatments might affect daily activities and quality of life, and what factors might influence the evolution over time of the impact of dialysis on daily activities and quality of life. Study Design Observational coh...
Article
Full-text available
Background. The rapidly evolving novel coronavirus 2019 (COVID-19) pandemic bought many kidney transplant (KT) programs to a halt. Integral to resuming KT activity is understanding the perspectives of potential transplant candidates during this highly dynamic time. Methods. From June 1 to July 7, 2020, a telephone survey of KT candidates on th...
Article
Full-text available
Introduction A better understanding of factors influencing perceived life expectancy, interactions between patient prognostic beliefs, experiences of illness and treatment behaviour is urgently needed. Methods Case-notes at three haemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their healthcar...
Article
Full-text available
Introduction Reported outcomes for older people with advanced chronic kidney disease (CKD) often focus on survival and mortality and little attention is paid to symptom burden and health-related quality of life. Recognising frailty and providing interventions that may improve outcomes have been studied in the general population with a growing resea...
Article
Full-text available
Background Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD). Methods We searched the Cochrane Kidney and T...
Article
Background and objectives People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternat...
Article
Full-text available
There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will...
Article
Background: While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to desc...
Article
Premature muscle tiring (fatigue) is an important complication of advanced kidney disease, and results in a reduced ability to walk and exercise. As patients move from pre-dialysis care to dialysis, they begin to lose their residual kidney function and experience muscle wasting. Not all patients on dialysis are affected equally by the loss of muscl...
Chapter
The demographics of the renal population have evolved, such that the elderly are the fastest growing group. Consequently, the multidisciplinary renal team often encounters clinical issues associated with advancing age. In this chapter, frailty, falls, and cognitive impairment are discussed as underrecognized geriatric syndromes in patients with chr...
Article
Full-text available
Background and Aims Early studies in peritonitis showed no difference in outcomes between anuric and non-anuric patients, despite pharmacokinetic studies showing the effect of residual renal function (RRF) on antibiotic clearance. Recent work identified a relationship between preserved RRF and treatment failure in gram-positive and culture-negative...
Article
The 2019 International Society for Peritoneal Dialysis (ISPD) Practice Recommendations were prepared by a committee invited by the ISPD to develop new practice recommendations for prescribing high-quality, goal-directed peritoneal dialysis (PD). Further input was sought at the stage of the first draft of the proposed recommendations by circulating...
Article
Background Patient burnout is a major cause of technique failure on peritoneal dialysis (PD). Reducing the PD prescription on an individual basis, dependent upon residual kidney function (RKF), may have a role in prolonging time on PD by reducing dialysis burden. This retrospective study aimed to determine the safety and impact of flexible PD presc...
Article
Full-text available
A key component of treatment for all people with advanced kidney disease is supportive care, which aims to improve quality of life and can be provided alongside therapies intended to prolong life, such as dialysis. This article addresses the key considerations of supportive care as part of integrated end-stage kidney disease care, with particular a...
Article
Full-text available
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation o...
Article
Full-text available
The number of frail patients reaching end-stage kidney disease is increasing. They have a high level of comorbidity and symptom burden which need to be considered when making management plans. For those who choose renal replacement therapy, it is important to establish goals and ceilings of care and to provide holistic care focusing on optimising q...
Article
Background Little is known about long-term survivors with encapsulating peritoneal sclerosis (EPS). Published literature focuses on patients managed surgically. We describe our experience of the long-term outcomes in patients with EPS conservatively managed with nutritional support alone. Methods This is a single-centre retrospective observational...
Article
Person-centered care has become a dominant paradigm in modern health care. It needs to be applied to people with end-stage kidney disease considering the initiation of dialysis and to peritoneal dialysis (PD) prescription and care delivery. It is relevant to their decisions about goals of care, transplantation, palliative care, and discontinuation...
Article
Peritoneal dialysis (PD) is only one component of care for older multimorbid, frail and/or palliative patients. Goals of care should be determined for all patients by shared decision-making at the start of during time on PD. Burden of PD should be minimized by individualizing the prescription by allowing for residual renal function and tailored to...
Article
Full-text available
Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities...
Article
Full-text available
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation o...
Article
Full-text available
ISPD Guidelines on Peritoneal Dialysis Access http://www.pdiconnect.com/content/early/2019/04/26/pdi.2018.00232.full.pdf
Article
The number of patients given renal replacement therapy (RRT) has expanded significantly over the last few decades, but it is increasingly recognized that such invasive treatment might not offer the intended and desired quality of life for very frail, elderly people and those with multiple co-morbidities. Comprehensive conservative care is an increa...
Article
♦Background: The most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit’s experience of repeat ESI and clinical outcomes in this cohort. ♦ ♦Methods: Retrospective case note review of al...
Article
Background: As the numbers of older patients on dialysis rise, geriatric problems such as falling become more prevalent. We aimed to assess the prevalence of falls and the impact on mortality and quality of life in frail elderly patients on assisted PD (aPD) and hemodialysis (HD) from the FEPOD Study. Methods: Data on falls and quality of life w...
Article
Full-text available
Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, a...
Article
Shared decision-making about clinical care options in end-stage kidney disease is limited by inconsistencies in the reporting of outcomes and the omission of patient-important outcomes in trials. Here we generated a consensus-based prioritized list of outcomes to be reported during trials in peritoneal dialysis (PD). In an international, online, th...
Chapter
Diabetes and age-related changes are now the commonest cause of end-stage renal disease (ESRD) in the UK. Polycystic kidney disease is the commonest inherited disorder leading to renal failure. Chronic renal failure implies permanent renal damage, which is likely to be progressive and will eventually require renal replacement therapy. Treatment of...
Article
Full-text available
Background: In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to i...
Article
Full-text available
Background: Patients who require acute initiation of dialysis have higher mortality rates when compared with patients with planned starts. Our primary objective was to explore the reasons and risk factors for acute initiation of renal replacement therapy (RRT) among patients with end-stage kidney disease (ESKD). Our secondary objective was to dete...
Article
Background and objectives: The absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver prioriti...
Article
Full-text available
There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and u...
Article
There has been a dramatic, worldwide expansion in life expectancy across the last century. This has resulted in a progressively more elderly and comorbid population. It is increasingly recognized that healthcare in this group needs to move to the concept of “adding life to years”. Recognition and assessment of frailty is vital in changing our appro...
Article
Full-text available
Background There is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted pe...
Article
Peritoneal dialysis (PD) can provide an improved quality of life to older patients requiring renal replacement therapy (RRT) compared to in-centre haemodialysis (HD). Frailty in the elderly poses challenges to PD, which may be met by assisted PD, and integration with geriatric and palliative services. The focus of PD care in the elderly should be o...
Article
Full-text available
People are living longer. On the whole, they have healthier lives and many of the problems previously seen at a younger age now appear in their later years. Kidneys, like other organs, age, and kidney disease in the aged is a prime example. In the United Kingdom, as in other developed countries, the prevalence of end stage kidney disease is highest...
Article
Background: Worldwide, approximately 11% of patients on dialysis receive peritoneal dialysis (PD). Whilst PD may offer more autonomy to patients compared with hemodialysis, patient and caregiver burnout, technique failure, and peritonitis remain major challenges to the success of PD. Improvements in care and outcomes are likely to be mediated by r...
Article
The guidelines for adults on peritoneal dialysis were largely based on trials from which older people were not included. As such, achieving the population's dialysis goals will require consideration of several additional factors. William White and Edwina A Brown discuss these aspects of care and explore how they can implemented into the older perso...
Article
Full-text available
The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease...
Article
Full-text available
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exis...
Chapter
The management of abdominal wall hernias is crucial for surgeons dedicated to peritoneal dialysis (PD). Common clinical scenarios which require different treatment algorithms, are represented by hernias diagnosed in pre-assessment (before peritoneal catheter insertion), during laparoscopic PD catheter insertion and post- operatively after dialysis...
Chapter
The decision to begin a patient on peritoneal dialysis should be a patient centered approach. For surgeons providing peritoneal access, a thorough knowledge of the anatomy, catheter choices and options for insertion is important. This chapter describes the many types of peritoneal dialysis catheters and compares them. In addition, there is a review...
Article
The impact of dialysis on cognitive trends is uncertain. Kurella Tamura et al. evaluated cognitive trajectories in 212 participants from the Chronic Renal Insufficiency Cohort study and found that dialysis initiation was associated with a decline in executive function. This is consistent with a cerebrovascular basis for cognitive impairment in pati...
Article
Full-text available
Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD)...
Chapter
The default dialysis choice for the elderly is usually haemodialysis in most European countries, Canada and the USA with relatively few patients starting on peritoneal dialysis (PD) compared to younger and fitter patients. This is actually quite surprising as a home-based treatment avoids the need for transport and peritoneal dialysis (PD) does not...
Chapter
Only a few patients over the age of 70 will be eligible for transplantation, so the older patient starting dialysis will remain on this treatment for the rest of their life. Choice of dialysis modality will not affect patient survival but will have a major impact on patient lifestyle and therefore quality of life. The decision about dialysis modali...
Article
Full-text available
Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis. Almost all frail and older patients receiving dialysis will default to in-center hemodialysis, although the availability of assisted peritoneal dialysis enables dialysis at home. As with any disease management decision, patients approaching end-...
Article
Frailty is highly prevalent in older people with chronic kidney disease and those on dialysis than in older people without kidney impairment. The Renal Unit at the Hammersmith Hospital has introduced an ongoing quality initiative project, aimed at supporting older patients on dialysis. In this article Carol Bartholomew et al discuss the outcomes of...
Article
Full-text available
Purpose: To identify and prioritize potential topics to be addressed in the development of European multidisciplinary guidelines on the management of chronic kidney disease stage 3b-5 in older patients. Methods: We composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatrici...
Article
Full-text available
Historic and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. As healthcare beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision-making at the end of life. The principles of truth telling and p...
Article
Full-text available
Background Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, however its relationship with aortic stiffness has yet to be investigated. Chronic kidney disease (CKD) has been identified as a risk factor for both myocardial and arterial disease. As such we sought to exp...