Care and Outcomes for Older Adults with Advanced Chronic Kidney Disease

The prevalence of older adults with advanced chronic kidney disease (CKD) is increasing globally, although optimal treatment remains uncertain. We examined in this thesis survival outcomes for older adults with kidney failure treated and not treated with dialysis. We also sought to identify barriers and facilitators to optimal conservative (non-dialysis) care for older adults with kidney failure managed by primary care physicians. We conducted three studies: a population-based retrospective cohort study using administrative and laboratory data to compare survival outcomes between dialysis and non-dialysis treatment; a qualitative descriptive study to explore primary care physician experiences when providing conservative care to older adults with kidney failure; and a cross-sectional population-based survey study within Alberta, Canada, to quantify results from the previous qualitative study. These last two studies formed a sequential exploratory mixed methods program of work to identify barriers and facilitators to community-based conservative care. We found that compared to non-dialysis care, dialysis was associated with a reduced risk of all-cause mortality but only within the first three years following onset of kidney failure. Conservative care for older adults is commonly provided by primary care physicians; however, they face substantial barriers to optimal care. Primary care physicians also expressed a need for resources including telephone access to nephrology or conservative care expertise, better access to conservative care clinics, and improved ability to appropriately co-manage patients with nephrologists. Research in conservative care has previously focused on patients with advanced CKD referred to nephrology. However, conservative care and outcomes among older adults not referred to nephrology is largely unknown. This thesis examined clinical care and outcomes through a wider perspective. To foster clinical impact we worked closely from conceptualization to dissemination stages with key stakeholders in Alberta including the Southern Alberta Conservative Management Program, the Conservative Kidney Management Pathway Steering Committee, the Kidney Health Strategic Clinical Network, and the Alberta College of Family Physicians. Our findings contributed to development of a conservative kidney management clinical care pathway and province-wide telephone access for primary care physicians to directly contact nephrologists and conservative care specialists.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Community Health Sciences

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2017

Author dc:creator

• Helen, Tam-Tham

Advisor dc:contributor.advisor

• Hemmelgarn, Brenda

Committee members dc:contributor.committeemember

• Fruetel, Karen
• King-Shier, Kathryn
• Quinn, Robert
• Thomas, Chandra

• Epidemiology

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

eng

DOI

http://dx.doi.org/10.11575/PRISM/25217

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:11023/3930