Edwina Brown

Edwina Brown
Imperial College Healthcare NHS Trust · Renal

DM (Oxon), FRCP

About

354
Publications
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Publications

Publications (354)
Article
Background Intraperitoneal pressure measurement offers therapeutic and prognostic benefits in predicting leak risks and gastrointestinal symptoms in Peritoneal Dialysis (PD) patients. This systematic review aims to evaluate the prognostic utility of intraperitoneal pressure measurements and different estimated intraperitoneal pressure equations in...
Article
Full-text available
Use of peritoneal dialysis and home haemodialysis remains low in Europe, with the highest use in Scandinavian countries and the lowest in Eastern and Central Europe despite the advantages for people on dialysis and economic advantages for healthcare systems. This is partly due to the impact of the haemodialysis industry resulting in proliferation o...
Article
Full-text available
Objectives Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists’ perspectives on techni...
Article
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Background Peritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mas...
Article
Full-text available
Peritoneal dialysis (PD) enables people to have a home-based therapy, permitting greater autonomy for individuals along with enhanced treatment satisfaction compared with in-center dialysis care. The burden of treatment on PD, however, remains considerable and underpins the need for person-centered care. This reflects the need to address the patien...
Article
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with...
Article
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Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has primarily related to numerical targets for laboratory measures and outcomes such as cardiovascular disease...
Article
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Rationale & objective: Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live. Study design: Scoping Review. Setting & study populations: People with kidney failure over 18 years old. Search strategy & sources: Studies we...
Article
Full-text available
Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per yea...
Article
Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to...
Article
Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to...
Article
Full-text available
Background Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frail...
Article
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The growing older population with advanced chronic kidney disease (ACKD stages 4–5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older peopl...
Article
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Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focussing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to impro...
Article
Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome hallmarked by the formation of a fibrous cocoon encapsulating the bowel resulting in morbidity and mortality. EPS is most frequently associated with peritoneal dialysis (PD), particularly with its discontinuation. While EPS is one of the most feared complications of PD, the majority of...
Article
Full-text available
Introduction Surprisingly few studies have explored the experiences of seriously unwell people with kidney disease on haemodialysis therapy: we conducted a mixed-methods study to investigate gender differences in illness experience, symptom burden, treatment considerations or expectations in this cohort. Methods Seriously unwell people on haemodia...
Poster
Long-term outcomes for persons who start peritoneal dialysis (PD) and then transition to haemodialysis (HD) are poorly understood. This study explored the outcomes of people transferring to HD within 12 months of PD start compared with those transferring after 12 months to inform strategies to reduce HD transition rates.
Article
Full-text available
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence s...
Article
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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...
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
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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
Full-text available
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...
Article
Introduction There are an increasing number of older people live with advanced kidney disease. These individuals tend to have a higher number of co-morbidities, including frailty. This group experience multiple challenges in understanding and managing their co-existing conditions. This quality improvement project aimed to incorporate patient and ca...
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
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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
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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
Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the...
Article
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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
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
Fitness for Work gathers together specialist advice on the medical aspects of employment, covering the majority of medical conditions that are likely to be encountered in the working population. The aim is to inform the best occupational health advice to employers, managers, and others about the impact of a patient’s health on work and how they can...
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...