Introduction
Various medical conditions associated with the impairment of proper kidney functioning can severely undermine the quality of life of patients. In such situations, a necessity for effective treatment arises in order to prolong the life of the person and reduce the negative effects of their disease. Conditions such as end-stage renal disease (ESRD) are particularly debilitating and can cause death in a short period of time if left unattended. Despite the fact that ESRD is a chronic disease that cannot be treated, there are methods capable of prolonging the life of a patient for several additional years. The advancements in the area of assisting patients with ESRD have led to positive results, and research indicates a considerable decrease in excess mortality over the past decades (Foster et al., 2018). One of the methods is Peritoneal Dialysis, a procedure that helps perform the functions of a kidney when it no longer filters waste products from the blood. The process of Peritoneal Dialysis can be conducted by utilizing different tools, namely, Venous Catheter (CVC), Arteriovenous Graft (AVG), and Arteriovenous Fistula (AVF), which potentially may produce different treatment outcomes for patients.
Peritoneal dialysis implies gaining access to the blood, which must be permanent since the procedure itself must be executed on a continuous basis replacing the functions of patients’ kidneys. Access to circulations is necessary for conducting the procedure and, therefore, for the prolongation of the patient’s life. While all of the options, namely CVC, AVG, and AVF, share the same main function of providing vascular access, choosing which one to use can be a difficult task. For a long period of time, the Arteriovenous Fistula has been a preferred option for dialysis procedures, and it has been promoted by clinical guidelines and various national initiatives (Shahinian et al., 2020). Yet, it is still unclear whether AVF can guarantee better results than other available means of conducting dialysis and whether it should be the ultimate choice for patients with additional comorbidities. Thus, there is a need for studying the effects of implementing each of the tools in order to discover whether one of them is capable of delivering superior treatment results. Namely, it is important to study the mortality rate associated with CVC, AVG, and AVF.
Problem Statement
The problem of the current study concerns the mortality rate associated with utilizing Venous Catheter (CVC) and the Arteriovenous Fistula (AVF) for conducting the procedure of Peritoneal Dialysis. The problem is significant due to the lack of evidence that would indicate that one of the tools can ensure a lower mortality rate in patients with severe kidney conditions. Moreover, since Peritoneal Dialysis is used primarily on patients with chronic kidney diseases, the procedure is particularly important for prolonging their life, and choosing the most effective way to do it is essential. Thus, the objective of the current research is to discover the mortality rate of the Venous Catheter (CVC) and the Arteriovenous Fistula (AVF). The findings of the study will contribute to the area of advanced practice nursing since it will provide important evidence on the effectiveness of two possible options for conducting Peritoneal Dialysis. The theoretical framework which will be utilized in the study will rely on conducting a quantitative analysis based on the regression method. Such a theoretical framework will guarantee to receive reliable and valid data, which will help researchers gain insight into the problem.
Literature Review
Peritoneal Dialysis vs. CVC/AVF: Mortality Rate
The kidney is one of the most valuable organs in the human body. It plays a critical role in filtering wastes and excess fluids from the human blood. However, some complications, such as chronic kidney disease (CKD), can reduce its functioning. CKD is the gradual loss of the kidney’s normal functioning with time. It may, in return, lead to the development of complications such as high blood pressure, low blood count, damage of nerves, and poor nutritional health. When prescribing medication, prevention of dialysis therapy is also crucial. Early nephrologist appointments have been shown to lower hospital stays and mortality (Ng & Li, 2018). Furthermore, recent studies on the widespread viral illness COVID-19 suggest a higher risk of coronavirus-related death (Gansevoort & Hilbrands, 2020).
Severe impairments of kidneys, issues with the cardiovascular system, and several other health concerns require the introduction of dialysis for the immediate management of a major health threat. However, the choice of the tool used for dialysis often defines the patients’ chances to survive, as well as the further prognosis concerning the patient’s life expectancy (Kim et al., 2020). Currently, three alternatives are utilized in clinical settings, namely, the Central Venous Catheter (CVC), Arteriovenous Graft (AVG), and the Arteriovenous Fistula (AVF) are utilized interchangeably to implement the procedure (Lee et al., 2019). However, despite their current perception as mutually replaceable tools, the levels of mortality in patients with said health impairments may be lower depending on the choice of the tool. Therefore, an in-depth comparison of the specified devices is needed, along with a thorough literature review. Indeed, a literature review containing the main points of selected articles, their strengths and weaknesses, and their significance for the study allows understanding of the issue fully. By carefully choosing search terms and taking a critical approach to the problem, difficulties like finding recent and pertinent papers can be avoided.
In situations where there is no other way to extend a patient’s life, the dialysis technique is the newest in a line of therapeutic treatments. Peritoneal dialysis is currently one of the most popular treatments for people with chronic renal failure (CRF) and the terminal stage of chronic kidney disease (CKD). This is because a huge proportion of patients with end-stage renal failure consists of persons with concomitant cardiovascular or systemic diseases, and for them, hemodialysis is contraindicated. As a result, peritoneal dialysis was widely used in urology practice. The quality of therapy with peritoneal dialysis is mainly determined by the reliability of the type of catheter used for penetration – it is either the Central Venous Catheter (CVC), or Arteriovenous Graft (AVG), and the Arteriovenous Fistula (AVF). According to several studies, a choice of the catheter can contribute to the factors that influence patients’ mortality rate. The goal of this literature review is to critically assess these studies.
When the kidneys no longer work, it is critical to receive dialysis to keep the body functioning as normal as possible; Dialysis gets rid of waste and toxins in the blood. Without dialysis, salt and wastes accumulate in the body and damage other organs.
The Impact of Peritoneal Dialysis on Patients’ Mortality Rate and Quality of Life
The quality of life of patients receiving kidney replacement therapy is one of the most crucial factors to consider. This problem remains the most acute because this group of patients feels constant dependence of their health and life on factors they have little control of. Vonesh et al. (2004) have found that “PD was associated with an increased risk of death in the 40% of the population comprised of Diabetes Mellitus patients aged 45 and older” (p. 2394). However, a thorough analysis performed in this study showed that mortality rates associated with peritoneal dialysis vary widely concerning many factors. Additionally, Vonesh et al. (2004) concluded that persistent improvements in PD techniques might decrease mortality risks.
In a different study, Kao et al. (2020) evaluated psychological issues related to unscheduled dialysis and how they affected patients’ quality of life. According to Kao et al. (2020), “the causes for sleep disturbance in CKD patients include depression, anxiety, uremic toxins, and adverse effects of drugs, as well as, potentially, the use of dialysis therapy” (p. 255). The conducted research evaluated specifically the influence of dialysis therapy on psychological disturbances through questionnaires and scientific analysis. However, the researchers did not find a significant correlation between unplanned dialysis and patients’ psychological condition. Still, it was advised that a multidisciplinary care program might help relieve the symptoms of anxiety and depression.
Another significant factor in the prescription of treatment is the prevention of dialysis therapy. According to research, scheduling a nephrologist consultation early lowers hospital stays and mortality (Ng & Li, 2018). Furthermore, recent studies on the prevalent virus COVID-19 suggest a higher risk of coronavirus-related death (Gansevoort & Hilbrands, 2020). These indicators force the development of new predictive methods and an integrated approach to dialysis patients. For example, a group of scientists has developed a method for predicting mortality based on retrospective administrative and clinical indicators of patients, considering the main causes: heart failure, metastatic cancer, and lymphoma (Wick et al., 2017). Although the proposed tool has not been validated, research in this direction may help guide clinical decisions for older people with renal failure.
Difficulties in Choosing the Catheter Type
Modern advanced laparoscopic techniques allow patients in need of kidney substitution therapy to successfully apply peritoneal dialysis, even in the case of concomitant abdominal pathologies. However, there are several aspects to the choice of a correct dialysis tool for each case. A significant study by Hagen et al. (2014) shows that “a PD catheter failure rate up to 35% is described, which certainly calls for improvement” (p. 922). The authors conducted a meta-analysis to determine the factors that might influence the PD failure associated with the catheter choice and identified the benefits of using different types of catheters. A study performed by Dell’Aquila et al. (2007) supports the issue, claiming that “overcoming catheter-related problems means giving a real chance to development of the peritoneal technique” (p. 119). However, this research did not imply in detail the process of catheter choice, rather stating that most of the catheter types could be used freely if special attention is paid to their care.
More detailed information on the use of certain types of catheters, such as arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC), was provided by Kim et al. (2020)’s research. Their findings identify that the “AVG group showed the worst patients’ survival among the three types of vascular accesses, while AVF presented the best results out of the three” (p. 33). Overall, the authors concluded that the use of AVF had the most impact on the patients’ mortality rate and depression score, specifically in the kidney disease field. The results of this study might be recommended to consider while choosing a catheter type due to their high reliability – the authors used a multidimensional approach when conducting analysis.
However, relevant research performed by Lee et al. (2018) has provided a counterargument to the preferred use of AVF for peritoneal dialysis. The authors claim that “AVF outcomes are uniformly worse among female patients due to a lower rate of success, a higher likelihood of assisted AVF use, and a higher potential of abandonment” (p. 18). According to their statistical analysis, AVG grafts might be a better choice for peritoneal dialysis in female patients.
Other Study Findings
CVC use is often associated with increased hospital admissions and mortality. However, a deeper analysis shows that it is not the very fact of using this type of catheter that leads to death, but rather the poor systemic state of patients and emergency therapy intervention with its use, and given the high economic costs of dialysis patients, this problem requires careful consideration (Shimizu et al.., 2020). In the case of emergency and planned initiation of dialysis, AVF is considered the preferred type since statistics indicate much lower mortality in patients who started treatment using this type of catheter (Ozeki et al., 2017). Oftentimes, a lack of data or misdiagnoses can disrupt statistical research and lead to inaccurate conclusions (Asakura & Kimura, 2017). Due to this, the identification of such clinical environmental factors associated with high mortality in the early stages of dialysis has the potential to create positive momentum and understanding in the management of advanced CKD and collaborative decision-making.
Design and Methodology
Research Methodology
The research will be a longitudinal randomized study of the patients receiving peritoneal dialysis (PD) due to chronic kidney disease (CKD). The sample includes 100 patients selected from 4 major US hospitals to measure the impact of catheter choice on PD patients’ quality of life. 60% of the patients in the sample are males, and 40% are females. The sample population’s ages range from 25 to 59 years old, with a mean age of 43,2 years. The main inclusion criteria are the confirmed diagnosis of CKD and a 2-month minimum duration of PD procedures.
The sample size is appropriate because it supports time- and cost-effective data collection in healthcare facilities located in a specific geographic area. The sample size ensures the integrity of the research and the detailed visualization of the dimensions included in the questionnaire. Moreover, it contains a 10% margin of missed responses, which means that the sample size of 90 respondents will be enough for the purpose of the study. The larger sample size would make the analysis process time-consuming, while insufficient size would pose the risk of false or inconsistent results.
Data Collection
The data collection will be conducted using the qualitative method of interviewing involving generic self-reported questionnaires (EQ-5D) to measure the quality of life in two randomized groups. The descriptive system will cover the dimensions of mobility, usual activities, self-care, pain, and depression. The reliability and consistency of the questionnaire can be achieved by conducting test-retest procedures reflecting the correlation between the scores or alternate-form testing based on the use of two different versions of the same questionnaire. The data from electronic health records (EHRs), containing medical history, laboratory testing results, and vital signs, will be utilized to provide consistent, objective, and reliable information on the sample population.
The concerns I have over reliability and validity are related to the trustworthiness of the study, and a way to overcome any concerns is to ensure that both reliability and validity are credible and confirmable. Reliability data will be collected with a large sample of patients and health care workers over at least two sites, one for peritoneal dialysis and one for CVC/AVF (Coventry et al., 2021). In order to identify potential areas for development or adjustment, a validity assessment will be conducted in collaboration with healthcare professionals who directly treat patients with CVD (Coventry et al., 2021). The study will provide recommendations for enhancing validity and reliability, however it is crucial to make sure that the data is steady and reliable (Souza et al., 2017). Validity and reliability are interdependent and cannot be evaluated independently.
Validity
The EQ-5D score will be analyzed to determine whether the dimensions’ variability depends on the catheter type (the Central Venous Catheter (CVC) or the Arteriovenous Fistula (AVF). The validity of the sample can be ensured by randomly allocating the patients into two groups using different catheter types. The predictive validity of the measurement tool (EQ-5D questionnaire) was demonstrated and proved in recent studies. For instance, Mlynczak and Golicky (2021) evaluated the tool via a machine learning algorithm and discovered evidence of its validity. The content validity of the questionnaire (readability, clarity, or comprehensiveness) can also be tested by experts familiar with the EQ-5D method and its use in CKD patients.
Working with healthcare professionals who directly treat patients with CVD, a validity assessment will be conducted to identify potential areas for improvement or change (Coventry et al., 2021). Although suggestions for enhancing validity and reliability vary depending on the study, it is crucial to make sure that the data is steady and reliable (Souza et al., 2017). It is impossible to evaluate validity and reliability independently as they are interdependent.
Ethical Considerations in Relation to Research
For the research to be conducted ethically, the participants should be aware of multiple responsibilities. Having multiple roles is not a problem if they do not affect the performance of the research. The informed consent regulations of the research should be followed. Those regulations should also increase motivation for performance among the participants. All those taking part in the research should ensure confidentiality and promise not to disclose the data collected. The most important of all is that those taking part in the project should be aware of the ethical obligations. A good working relationship among the participants is paramount as it will help share intellectual property openly.
Informed Consent for Participants
Title of the Research Study: Peritoneal Dialysis vs. CVC/AVF Mortality Rate
Investigators:
- Purpose: The main aim of this research is to investigate the level at which CVC/AVF causes mortality rate. The Impact of Peritoneal Dialysis on Patients’ Mortality Rate and Quality of Life and finally the challenges faced while selecting the Catheter type.
- Procedures: If any student wants to participate in this research, they will have to undergo testing both oral and practical. Their level of patience, confidentiality, and relationship with other members of the group will be done practically. They will be asked questions about their ability to do multiple tasks.
- Risks: There might be small challenges in this research that may risk the physical well-being of the participants. In the lab, while mixing chemicals, there might be explosions. Impolite responses from people during interviews may also be another risk, but the participants should be able to handle the interviewee.
- Benefits: Active participation in the research will enable students to get first-hand information hence enhancing their understanding of the data collected. It will also enable learners to exercise the knowledge they learn in class about data collection.
- Contact Information: Provide information about a family member, relative or close friend that will be contacted in case something goes wrong.
- Consent Statement: This is an assurance that I have read all the instructions, and I will abide by the rules all through the research till its completion.
Signature of the Subject
Recruitment of Participants
Before recruiting any participants, the following should be considered. The individual should uphold privacy, as it is important that the data collected should remain private because if revealed to the public, it may have negative effects. The individual should be willing to participate because working under pressure may lead to poor results. Anyone who wants to participate should master the study in that they should describe it accurately and clearly (Lin et al., 2020). With the information on what the research requires, data collection will be easy as it will provide a rough idea of what is required during exploration. The individuals participating should avoid being biased with the information while presenting. They should be able to present balanced information that is not too ambiguous or one that gives false hope to the patients. They should be aware of any misleading information and misconceptions they might have acquired during the study. That means that the individual should be an intense researcher willing to deliver the required information.
Incentives for the Project
By participating in this project, you will be able to learn more than what is learned in class, and that will add to an individual’s general knowledge. During the research, accommodation will be free, and there will be an additional allowance. Materials needed for the research will be provided, and necessary funding will be done by the sponsor of this project. What motivates this research most is that in the long run, after analyzing the information collected, they will be able to offer a possible solution to this problem of CVC/AVF and mortality rate.
Quantitative Data Collection
During this research, the effect of peritoneal Dialysis on Patients’ mortality rate will be investigated. The number of patients that require peritoneal dialysis per week in the sample hospitals will be selected. The quality of life of the patients and expectant mothers will also be considered. The group of patients under this investigation is thought to be affected by factors that cannot be fully controlled as part of the research. The impact of unplanned dialysis on the quality of life of the patients will be studied as well. Precautions that doctors and individuals should take to avoid these conditions will also be researched. The problems encountered while trying to select the appropriate catheter type will be examined. Detailed information about the use of various types of catheters will also be scrutinized (Shimizu et al., 2020). Conclusions will be made based on the data collected during the interviews and statistics.
Method of Collecting Data
To find out how many patients in particular hospitals are impacted by this ailment, a survey will be carried out. My research topic compares mortality rates related to the implementation of peritoneal dialysis and CVC/AVF. As the central issue of my research is statistical data, I plan to review hospital medical records related to the fatal outcomes of both methods. In this case, a previous study conducted by other specialists also could be helpful.
Issuing questionnaires to the patients and clinicians is one of the techniques used. Both the patients and the health offices will have questionnaires but with different questions. This will help get the thoughts of patients on how doctors react to these conditions. Answers from doctors will tell us the precautions to prevent his condition and ways in which its effect can be reduced. Observation will help us identify the signs of the conditions under investigation. A survey will be carried out to determine how many patients in particular hospitals are impacted by this ailment.
Moreover, during the collection process, I also decided to introduce a patient survey related to their well-being and satisfaction with using these methods. Talking about possible challenges in data collection, hospitals, and medical organizations could refuse my application to access medical records due to privacy concerns. A viable option in solving this problem could be creating a contract that will cover all ethical issues and limit my rights to distribute any personal information not related to research.
Independent and Dependent Variables
CKD may also be caused by somebody disorders and even diabetes. However, detecting the disease early and treating it can keep the condition from getting worse. Kidney failure may require dialysis or a kidney transplant to maintain everyday life. The independent variables in chronic kidney disease include age, gender, and marital status of the patients. Moreover, weight, height, and laboratory measurements such as hemoglobin levels are the dependent variables. When analyzed deeply, these variables give out an implication on the chronic kidney disease to patients who are ailing from it. Thus, the research questions on CKD were as indicated below.
1. In patients with CKD, does the use of peritoneal dialysis increase the likelihood of survival compared to the CVC and AVF and the mortality rates by at least 10% that they cause on the time slot of a month?
Why is it important?
Data Analysis Methodology
My anticipated quantitative analysis method is a regression since it suits this type of research. Firstly, it measures the association between variables, especially the numerical ones (Hocher & Adamski, 2017). It can also be used to make predictions on future impacts of the disease on future populations. The use of dialysis is always associated with great risks since it is often the only way to prolong the patient’s life. Regression analysis provides a strong theoretical basis for the test relationship from a probabilistic point of view. From sampled data, in which, as a rule, abrupt outliers are not observed, it is possible to build a model that meets the research questions. In addition, a wide range of regression tools, ranging from least squares to polynomial regression, will allow searching for dependencies in different ways.
Regression analysis is suitable for tasks in which independent variables are associated with dependent variables, and it is necessary to determine the nature of this relationship, its presence, and correlation and be able to predict based on the data obtained. The identification of factors, as well as the predictive function of this analysis, is extremely important in matters relating to patient health, which can really help in proactive counteraction of the disease and adequate use of dialysis therapy. This information can also be obtained experimentally and empirically, however, too high risks and many deaths of patients exclude this possibility.
Hypothesis
The hypothesis of this work – “the survival rate of dialysis patients, depends on the type of catheter used with the specifics of age, and gender” – is related to the research questions. The resulting statistical significance will indicate the likelihood of error, and the hypothesis, tested with a determining significance level greater than 0.05, states that patients with risk factors are more likely to have a stroke. In this case, according to the first research question, it is necessary to find the very fact of dependence, and according to the second – its determinant or cause.
Conclusion
Recent studies in the field of the pathogenesis of chronic renal failure show a wide multitude of factors influencing the outcomes of the treatment. Because of its greater reliance on outside variables, like catheter type, peritoneal dialysis continues to be one of the most talked-about methods among them. Still, the improvements in approaches to kidney disease complications and concomitant pathologies treatment and intensive development of dialysis technologies open wide prospects for optimizing long-term treatment results of patients with CKD. Studies from this literature review show that problems associated with dialysis therapy can be partially prevented with the right approach to the choice of tools at the beginning of treatment. Additionally, they point out the necessity of a timely change of approach if the capabilities of the technique in a particular patient are exhausted, or the risks of damage are too high. However, further research is required to determine the extent of the issue and plan the interventions to reduce the associated risks.
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