Fluid and blood pressure management in the dialysis population

Sub-optimal fluid and blood pressure management both contribute to the high rates of hospitalization and death experienced by individuals receiving hemodialysis. We conduct observational and prospective studies related to the following fluid-related topic areas: extracellular volume management, dialytic fluid removal (ultrafiltration) rate, dialysis frequency and duration, sodium management, and intradialytic hypotension and hypertension.

Patient-reported outcomes and patient preferences in the dialysis population

Patient-reported outcomes (PROs) such as symptoms, quality of life, or patient perceived health status are reports of the status of a patient’s condition that come directly from the patient, without amendment or interpretation of the patient’s response by a clinician or anyone else. Our PRO research aims to improve the quality of dialysis care delivery and patient outcomes through development and implementation of PRO measures. To assess patient preferences among dialysis patients, we conduct qualitative research (interviews, focus groups) to inform intervention, measure, and health education materials development. Our current efforts focus on improving recognition and treatment of symptoms, developing a dialysis care process to promote alignment of the dialysis treatment plan with patient-identified priorities, and piloting a novel intervention targeting key patient and care process barriers to pre-dialysis arteriovenous access creation.

Stakeholder engagement to inform, facilitate and improve dialysis research

Effective stakeholder engagement in research design, implementation and dissemination has the potential to enhance research quality and the clinical uptake of research findings. Dialysis research, in particular, involves numerous key stakeholders including patients, care partners, dialysis clinic personnel, medical providers, dialysis organization professionals, and healthcare payers. Our stakeholder engagement research focuses on effective stakeholder engagement as a means to improve both research processes and clinical care in dialysis clinics.

Patient-Centered Outcomes Research Institute (PCORI) Engagement Award: Building Research Capacity in the Dialysis Community at the Local Level

Medication safety and effectiveness in the dialysis population

Individuals receiving maintenance dialysis therapy possess a tremendous comorbid disease burden that typically requires treatment with multiple medications (on average, 10-12 medications per day). The safety and efficacy of many marketed medications have not been studied via randomized controlled trials in the dialysis population, a population with special drug dosing considerations. In our pharmacoepidemiologic research, we use administrative claims and electronic health record data to conduct large-scale comparative safety and effectiveness studies in efforts to provide evidence to guide medication prescribing in the dialysis population.