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During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients’ feelings of “copresence”—a sense of connection with another interactant via digital technology—with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients’ anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient’s need to reach out to their health care provider during a time when health care resources are being stretched.

Background The aim of this study was to determine the long-term effect of increasing water intake in patients with autosomal dominant polycystic kidney disease (ADPKD) on longitudinal changes in health-related quality of life (HRQoL) in the setting of a clinical trial. Methods Self-completed HRQoL (using the KDQoL-SF, v.1.3 questionnaire) was assessed annually in participants of a 3-year randomized controlled clinical trial (n  = 187), allocated (1:1) either to increase water intake to reduce urine osmolality to ≤270 mosmol/kg (implemented by dietetic coaching, self-monitoring tools, text messaging) or continue usual water intake. Results Overall, 96% and 81.8% of participants (n  = 187) completed the questionnaire at the baseline and final study visits, respectively. At baseline, the physical component summary score (PCS) and mental component summary score (MCS) were similar in the two groups (P > 0.05) and the five dimensions with the lowest scores in both groups were: energy and fatigue; general and overall health; sleep; emotional well-being; and pain. Within each group, there were no longitudinal changes over time. At the final visit, the PCS was higher in the increased water intake group (51.3 ± 7.6, mean ± standard deviation) compared to the usual water intake group 48.8 ± 9.3; P = 0.037) whereas the MCS was numerically similar. The improvement in the PCS was due to higher sub-scale values for physical functioning and pain (both P < 0.05). By multivariate analysis, only baseline PCS and height-corrected total kidney volume were associated with the final PCS (P < 0.05). Conclusion HRQoL scores remained stable over a 3 year period, and were not adversely affected by the intervention to increase water intake. Future studies should evaluate the clinical significance of the higher PCS in the increased water intake group. [ABSTRACT FROM AUTHOR]

Background Peritoneal dialysis (PD) solutions containing low levels of glucose degradation products (GDPs) are associated with attenuation of peritoneal membrane injury and vascular complications. However, clinical benefits associated with neutral-pH, low-GDP (N-pH/L-GDP) solutions remain unclear. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the associations between N-pH/L-GDP solutions and all-cause mortality, cause-specific mortality, transfer to haemodialysis (HD) for ≥30 days and PD peritonitis in adult incident PD patients in Australia and New Zealand between 1 January 2005 and 31 December 2020 using adjusted Cox regression analyses. Results Of 12 814 incident PD patients, 2282 (18%) were on N-pH/L-GDP solutions. The proportion of patients on N-pH/L-GDP solutions each year increased from 11% in 2005 to 33% in 2017. During the study period, 5330 (42%) patients died, 4977 (39%) experienced transfer to HD and 5502 (43%) experienced PD peritonitis. Compared with the use of conventional solutions only, the use of any form of N-pH/L-GDP solution was associated with reduced risks of all-cause mortality {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61–0.74]}, cardiovascular mortality [aHR 0.65 (95% CI 0.56–0.77)], infection-related mortality [aHR 0.62 (95% CI 0.47–0.83)] and transfer to HD [aHR 0.79 (95% CI 0.72–0.86)] but an increased risk of PD peritonitis [aHR 1.16 (95% CI 1.07–1.26)]. Conclusions Patients who received N-pH/L-GDP solutions had decreased risks of all-cause and cause-specific mortality despite an increased risk of PD peritonitis. Studies assessing the causal relationships are warranted to determine the clinical benefits of N-pH/L-GDP solutions. [ABSTRACT FROM AUTHOR]

Background: People with kidney failure face a multitude of psychosocial stressors that affect disease trajectory and health outcomes. Objectives: To investigate psychosocial factors affecting people with kidney failure before or at start of kidney replacement therapy (KRT) and kidney supportive and palliative care (KSPC) phases of illness and to explore role of social worker during the illness trajectory. Methods: We conducted a secondary data audit of patients either before or at start of KRT (Phase 1) and at the KSPC (Phase 2) of illness and had psychosocial assessments between March 2012 and March 2020 in an Australian setting. Results: Seventy‐nine individuals, aged 70 ± 12 years, had at least two psychosocial assessments, one in each of the two phases of illness. The median time between social worker evaluations in Phase 1 and Phase 2 was 522 (116−943) days. Adjustment to illness and treatment (90%) was the most prevalent psychosocial issue identified in Phase 1, which declined to 39% in Phase 2. Need for aged care assistance (7.6%−63%; p < 0.001) and carer support (7.6%−42%; p < 0.001) increased significantly from Phase 1 to Phase 2. There was a significant increase in psychosocial interventions by the social worker in Phase 2, including supportive counselling (53%−73%; p < 0.05), provision of education and information (43%−65%; p < 0.01), and referrals (28%−62%; p < 0.01). Conclusion: Adults nearing or at the start of KRT experience immense psychosocial burden and adaptive demands that recognisably change during the course of illness. The positive role played by the nephrology social worker warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: The association of smoking with new‐onset cardiovascular disease, chronic lung disease, malignancy and mortality in dialysis is well‐known. The smoking prevalence and its association with clinical outcome was assessed. Methods: Multicentre cohort study using 'ANZDATA' Registry, 57 838 adults who commenced dialysis (>3 months) between 1990 and 2016 were included. Patients' demographics, initial dialysis modality, presence of comorbidities and smoking history are predictors. The primary outcome was all‐cause mortality. Secondary outcomes were smoking prevalence, cause‐specific mortality, non‐skin cancers, cardiovascular and chronic lung diseases. Results: Of the 57 838 patients, 56 512 (mean age of 58.9 ± 15.1 years, 40.1% female, 43% diabetic), had data on smoking history with 13.6% current, 40.7% former and 45.6% never smokers. Former and current smokers had 10% (HR 1.10; 95% CI: 1.08, 1.13) and 22%(HR 1.22; 95% CI: 1.18, 1.26) higher risk of all‐cause mortality. They were 13% (HR 1.13; 95% CI: 1.09, 1.18) and 23% (HR 1.23; 95% CI: 1.17, 1.29) for CVD mortality. Smoking was associated with higher mortality from respiratory failure (HR 1.59; 95% CI: 1.13, 2.23, p =.073 and HR 1.33; 95% CI: 1.01, 1.74, p =.042) for current and former smokers. Current and former smokers had higher risk for non‐skin cancer (HR 1.30; 95% CI: 1.19, 1.42 and HR 1.24; 95% CI: 1.17, 1.32). Smoking was associated with a higher rate of death from cancer (HR 1.26; 95% CI 1.19–1.33) and chronic lung disease (HR 1.48; 95% CI 1.15–1.92). Former and current smokers had a higher adjusted risk for de novo vascular disease (PVD, CVD), CAD (adjusted RR 1.1; 95% Cl: 1.09–1.12). Conclusions: In dialysis patients, smoking was associated with higher rates of all‐cause mortality, cardiovascular mortality, respiratory failure, chronic lung disease and malignancy along with higher risks of non‐skin cancers, de novo vascular disease and chronic lung disease. Summary at glance: Cigarette smoking is a very well‐known risk factor for mortality in dialysis patients. This is the first manuscript analysing hazardous effects of smoking by using the ANZDATA Registry. Besides well‐known negative impact on all‐cause mortality and chronic diseases, smoking trends in different age groups and time periods were reported in this study. This study underlines the negative impact of smoking in dialysis population. New guidelines and preventive measures should be designed according to different age groups. [ABSTRACT FROM AUTHOR]