Transitioning patients with advanced chronic kidney disease to home or facility dialysis: understanding the experience and quality of life for patients and their caregivers (TRANSIT-CARE)

For people with advanced kidney disease, deciding which type of dialysis is best can be challenging. Studies have shown that quality of life is very important to patients. It is thought that the quality of life of people receiving their dialysis at home is better than the one of people receiving dialysis in a hospital. However, we do not know how the start of dialysis changes the quality of life of people who choose home dialysis in comparison to people choosing dialysis in a hospital. We also believe that people who receive dialysis at home have a better health, mobility, and function level than people with dialysis in hospital. Currently, it is uncertain if people receiving home dialysis can maintain their functioning level after start of dialysis. We also do not know if frail people starting dialysis at home will have a better functioning level after 1 year than those starting dialysis in hospital. We will perform a prospective mixed methods study following adult with advanced kidney disease who progress to dialysis and receive home or hospital-based dialysis. In this study, we aim to examine the trajectory and change in patients’ quality of life and their frailty status (health, mobility and function) before start of dialysis and up to 12-month after start. We will compare the differences between people doing home dialysis and hospital-based dialysis. We will use questionnaires to measure quality of life and tools to evaluate frailty. We will also perform semi-structured interviews with patients and their caregiver before and after the initiation of dialysis to better understand their experience of transitioning to dialysis. We hope that the results of this study will improve the care of people starting dialysis, at home and in hospital. This study will inform kidney teams on periods where patients may need more support before and after start of dialysis, and help to design interventions to improve patient's experience on dialysis.