E M McMahon, G Cully, P Corcoran, E Arensman, E Griffin
Advancing early detection of suicide? A national study examining socio-demographic factors, antecedent stressors and long-term history of self-harm
Journal of affective disorders
conservative kidney management ckm viable treatment option many patients chronic kidney disease however ckm practices resources united states well described undertook study gain better understanding factors influencing uptake ckm describing 1 characteristics patients choose ckm 2 provider practice patterns relevant ckm 3 ckm resources available providers crosssectional study study crosssectional analysis data us nephrology clinics enrolled chronic kidney disease outcomes practice patterns study ckdopps collected 2014 2020 data study includes chartabstracted characteristics patients estimated glomerular filtration rate 30mlmin173m2 n1018 available information whether decision made pursue ckm time kidney failure patient n407 reports discussions forgoing dialysis provider n26 responses ckm delivery available resources health systems descriptive statistics used report patient demographics clinical information provider demographics clinic characteristics among data 1018 patients 68 7 recorded planning ckm patients older comorbidities likely require assistance transfers 407 patient surveys 18 reported conversation forgoing dialysis nephrologist majority providers felt comfortable discussing ckm however clinics dedicated clinic protocol ckm inconsistent survey terminology unlinked patient provider responses patients reported discussion forgoing dialysis providers even fewer anticipated choice ckm reaching kidney failure providers comfortable discussing ckm practiced clinics lacked dedicated resources research needed improve implementation ckm pathway older comorbid adults kidney failure conservative kidney management ckm appropriate treatment choice ckm holistic approach treatment goals maximizing quality life preventing progression chronic kidney disease ckd without initiation dialysis investigated us ckm practices found among 1018 people ckd 7 planning ckm 407 surveyed patients 18 reported conversation provider forgoing dialysis contrast providers felt comfortable discussing ckm however none reported working environment dedicated ckm clinic protocol data show need ckm education united states well dedicated resources delivery