Jyoti Baharani | The University of Birmingham (original) (raw)

Papers by Jyoti Baharani

International Urology and Nephrology

Background: Cognitive impairment is common in haemodialysis (HD) patients and is associated indep... more Background: Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality. This association is poorly understood, and no intervention is proven to slow cognitive decline. There is evidence that cooler dialysis fluid (dialysate) may slow white matter changes in the brain, but no study has investigated the effect of cooler dialysate on cognition. This study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients.Methods: This is a multi-site prospective randomised, double-blinded feasibility trial. Setting: Four HD units in the United Kingdom.: Participants and interventions Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5C) or intervention (dialysate temperature 35°C) for 12 months. Primary outcome measure: Change in cognition using the Montreal Cognitive Assessment (MoCA). Secondary outcome measures: Recruitment and attrition ...

PLOS ONE

To explore staff perceptions of barriers to the identification of mild to moderate distress and t... more To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.

Poster presentations

Background The End of Life Care in Advanced Kidney Disease Framework suggests identifying patient... more Background The End of Life Care in Advanced Kidney Disease Framework suggests identifying patients approaching the end of life using a register to facilitate care planning, improve communication, co-ordinate service delivery and provide bereavement support. We aimed to survey the use of these registers in UK Renal units. Methods Anonymous structured questionnaires were distributed electronically to UK Renal units. Results 59% of respondents formally identified patients using a register. The commonest methods used to identify these patients included worsening symptoms despite optimal management (100%), deteriorating performance status, increasing care needs (95%) and unplanned hospital admissions (80%). Registers triggered interventions including discussions about resuscitation status (100% of units using registers compared with 50% not using registers), advance care planning (95% of units using registers compared with 43% not using registers), communication with GP (90% of units using registers compared with 50% not using registers) and referral to palliative care services (80% of units using registers compared with 21% not using registers). 88% of respondents discussed these patients with palliative care teams and 15% invite palliative care professionals to their MDT meetings. 21% use a structured pathway to withdraw dialysis. Nearly half of units surveyed did not use a formal bereavement pathway for the deceased's next of kin.

BMJ Open

ObjectiveTo explore why transplant patients experience unexpected mild-to-moderate distress and w... more ObjectiveTo explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need.DesignQualitative study using individual in-depth interviews.SettingFour National Health Service (NHS) Trusts in the Midlands, UK.ParticipantsFifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers.Main outcome measuresIdentification of the reasons for distress and support options acceptable to renal transplant patients.ResultsThree themes were interpreted from the data: ‘I am living with a “foreign body” inside me’, ‘why am I distressed?’ and ‘different patients want different support’. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditio...

Nephrology Dialysis Transplantation

Background and Objectives The Acute Kidney Outreach to Reduce Deterioration and Death trial was a... more Background and Objectives The Acute Kidney Outreach to Reduce Deterioration and Death trial was a large pilot study for a cluster-randomized trial of acute kidney injury (AKI) outreach. Methods An observational control (before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the intervention (after) phase, a working-hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were at the end of life, unlikely to benefit from outreach, lacking mental capacity or already referred to the renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. A tot...

Saudi Journal of Kidney Diseases and Transplantation

BMC Health Services Research

Background Lower-level emotional and psychological difficulties (‘distress’) in patients with end... more Background Lower-level emotional and psychological difficulties (‘distress’) in patients with end stage renal disease (ESRD), can lead to reduced quality of life and poor clinical outcomes. National guidelines mandate provision of emotional and psychological support for renal patients yet little is known about the support that patients may require, or the challenges that staff experience in identifying and responding to patient distress. Methods Mixed methods study in renal units at four NHS Trusts in the West Midlands, UK involving cross-sectional surveys of ESRD patients and renal unit staff and semi-structured interviews with 46 purposively-sampled patients and 31 renal unit staff. Interviews explored patients’ experience of distress and personal coping strategies, staff attitudes towards patient distress and perceptions of their role, responsibility and capacity. Results Patient distress was widespread (346/1040; 33.3%), and emotional problems were frequently reported. Younger p...

Saudi Journal of Kidney Diseases and Transplantation

BMJ Open

ObjectivesTo assess the prevalence of mild-to-moderate distress in patients with end-stage renal ... more ObjectivesTo assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics.DesignCross-sectional survey using emotion thermometer and distress thermometer problem list.SettingRenal units in four hospital Trusts in the West Midlands, UK.ParticipantsAdult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant.OutcomesThe prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs.ResultsIn total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalenc...

Peritoneal Dialysis International

The weighted catheter has shown promising results in retrospective and randomized studies. We exa... more The weighted catheter has shown promising results in retrospective and randomized studies. We examined its usefulness in patients with previous failed non-weighted peritoneal dialysis (PD) catheters or previous abdominal surgery. The insertion, start, end, and removal dates were recorded for all-type catheter insertions from 2011 to 2016. Primary and secondary failure rates were recorded, defined as failure to ever establish flow (primary) or failure after a period of successful PD (secondary). Patients were censored from analysis if PD ended due to death, transfer of care, transfer to hemodialysis, transplantation, or if the patient recovered renal function. There were 44 weighted, 75 non-weighted open surgical, and 143 percutaneous catheters. There was previous abdominal surgery in 29% and 6% of patients receiving surgically inserted and percutaneous catheters, respectively (p < 0.0001). Primary failure rates were 4/44 (9%), 20/75 (27%), and 26/143 (18%) in weighted, non-weighted surgical, and percutaneous catheters, respectively. There were reduced primary and secondary failure rates in the weighted (9% primary and 15% secondary) versus non-weighted surgically inserted group (27% primary and 46% secondary) (p = 0.04). There was no difference between primary (p= 0.15) and secondary (p = 0.5) failure rates between weighted and percutaneously inserted catheters. Kaplan-Meier survival analysis revealed overall increased catheter survival in the weighted group (p = 0.02). Weighted catheters were associated with increased survival and decreased failure rates compared with non-weighted surgical catheters, despite usage in patients at higher risk of catheter failure due to previous failed catheters and abdominal surgery.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

The relationship between frailty and chronic kidney disease in elderly population has been recogn... more The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities wer...

Blood purification, Jan 16, 2018

Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it i... more Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. Eight-two patients completed both tests - median age 73 (52-91) years, 59% male, dialysis vintage 41 (3-88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. Cognitive function declines over a haemodialysis session an...

Nephrology Dialysis Transplantation

Nephrology Dialysis Transplantation

International Urology and Nephrology

Background: Cognitive impairment is common in haemodialysis (HD) patients and is associated indep... more Background: Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality. This association is poorly understood, and no intervention is proven to slow cognitive decline. There is evidence that cooler dialysis fluid (dialysate) may slow white matter changes in the brain, but no study has investigated the effect of cooler dialysate on cognition. This study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients.Methods: This is a multi-site prospective randomised, double-blinded feasibility trial. Setting: Four HD units in the United Kingdom.: Participants and interventions Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5C) or intervention (dialysate temperature 35°C) for 12 months. Primary outcome measure: Change in cognition using the Montreal Cognitive Assessment (MoCA). Secondary outcome measures: Recruitment and attrition ...

PLOS ONE

To explore staff perceptions of barriers to the identification of mild to moderate distress and t... more To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.

Poster presentations

Background The End of Life Care in Advanced Kidney Disease Framework suggests identifying patient... more Background The End of Life Care in Advanced Kidney Disease Framework suggests identifying patients approaching the end of life using a register to facilitate care planning, improve communication, co-ordinate service delivery and provide bereavement support. We aimed to survey the use of these registers in UK Renal units. Methods Anonymous structured questionnaires were distributed electronically to UK Renal units. Results 59% of respondents formally identified patients using a register. The commonest methods used to identify these patients included worsening symptoms despite optimal management (100%), deteriorating performance status, increasing care needs (95%) and unplanned hospital admissions (80%). Registers triggered interventions including discussions about resuscitation status (100% of units using registers compared with 50% not using registers), advance care planning (95% of units using registers compared with 43% not using registers), communication with GP (90% of units using registers compared with 50% not using registers) and referral to palliative care services (80% of units using registers compared with 21% not using registers). 88% of respondents discussed these patients with palliative care teams and 15% invite palliative care professionals to their MDT meetings. 21% use a structured pathway to withdraw dialysis. Nearly half of units surveyed did not use a formal bereavement pathway for the deceased's next of kin.

BMJ Open

ObjectiveTo explore why transplant patients experience unexpected mild-to-moderate distress and w... more ObjectiveTo explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need.DesignQualitative study using individual in-depth interviews.SettingFour National Health Service (NHS) Trusts in the Midlands, UK.ParticipantsFifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers.Main outcome measuresIdentification of the reasons for distress and support options acceptable to renal transplant patients.ResultsThree themes were interpreted from the data: ‘I am living with a “foreign body” inside me’, ‘why am I distressed?’ and ‘different patients want different support’. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditio...

Nephrology Dialysis Transplantation

Background and Objectives The Acute Kidney Outreach to Reduce Deterioration and Death trial was a... more Background and Objectives The Acute Kidney Outreach to Reduce Deterioration and Death trial was a large pilot study for a cluster-randomized trial of acute kidney injury (AKI) outreach. Methods An observational control (before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the intervention (after) phase, a working-hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were at the end of life, unlikely to benefit from outreach, lacking mental capacity or already referred to the renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. A tot...

Saudi Journal of Kidney Diseases and Transplantation

BMC Health Services Research

Background Lower-level emotional and psychological difficulties (‘distress’) in patients with end... more Background Lower-level emotional and psychological difficulties (‘distress’) in patients with end stage renal disease (ESRD), can lead to reduced quality of life and poor clinical outcomes. National guidelines mandate provision of emotional and psychological support for renal patients yet little is known about the support that patients may require, or the challenges that staff experience in identifying and responding to patient distress. Methods Mixed methods study in renal units at four NHS Trusts in the West Midlands, UK involving cross-sectional surveys of ESRD patients and renal unit staff and semi-structured interviews with 46 purposively-sampled patients and 31 renal unit staff. Interviews explored patients’ experience of distress and personal coping strategies, staff attitudes towards patient distress and perceptions of their role, responsibility and capacity. Results Patient distress was widespread (346/1040; 33.3%), and emotional problems were frequently reported. Younger p...

Saudi Journal of Kidney Diseases and Transplantation

BMJ Open

ObjectivesTo assess the prevalence of mild-to-moderate distress in patients with end-stage renal ... more ObjectivesTo assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics.DesignCross-sectional survey using emotion thermometer and distress thermometer problem list.SettingRenal units in four hospital Trusts in the West Midlands, UK.ParticipantsAdult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant.OutcomesThe prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs.ResultsIn total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalenc...

Peritoneal Dialysis International

The weighted catheter has shown promising results in retrospective and randomized studies. We exa... more The weighted catheter has shown promising results in retrospective and randomized studies. We examined its usefulness in patients with previous failed non-weighted peritoneal dialysis (PD) catheters or previous abdominal surgery. The insertion, start, end, and removal dates were recorded for all-type catheter insertions from 2011 to 2016. Primary and secondary failure rates were recorded, defined as failure to ever establish flow (primary) or failure after a period of successful PD (secondary). Patients were censored from analysis if PD ended due to death, transfer of care, transfer to hemodialysis, transplantation, or if the patient recovered renal function. There were 44 weighted, 75 non-weighted open surgical, and 143 percutaneous catheters. There was previous abdominal surgery in 29% and 6% of patients receiving surgically inserted and percutaneous catheters, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Primary failure rates were 4/44 (9%), 20/75 (27%), and 26/143 (18%) in weighted, non-weighted surgical, and percutaneous catheters, respectively. There were reduced primary and secondary failure rates in the weighted (9% primary and 15% secondary) versus non-weighted surgically inserted group (27% primary and 46% secondary) (p = 0.04). There was no difference between primary (p= 0.15) and secondary (p = 0.5) failure rates between weighted and percutaneously inserted catheters. Kaplan-Meier survival analysis revealed overall increased catheter survival in the weighted group (p = 0.02). Weighted catheters were associated with increased survival and decreased failure rates compared with non-weighted surgical catheters, despite usage in patients at higher risk of catheter failure due to previous failed catheters and abdominal surgery.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

The relationship between frailty and chronic kidney disease in elderly population has been recogn... more The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities wer...

Blood purification, Jan 16, 2018

Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it i... more Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. Eight-two patients completed both tests - median age 73 (52-91) years, 59% male, dialysis vintage 41 (3-88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. Cognitive function declines over a haemodialysis session an...

Nephrology Dialysis Transplantation

Nephrology Dialysis Transplantation