Using the knowledge-to-action framework to guide the timing of dialysis initiation.
OBJECTIVE
The optimal time at which to initiate chronic dialysis remains unknown. Using a contemporary knowledge translation approach (the knowledge-to-action framework), a pan-Canadian collaboration (CANN-NET) set out to study the scope of the problem, then develop and disseminate evidence-based guidelines addressing the timing of dialysis initiation. The purpose of this review is to summarize the key findings and describe the planned Canadian knowledge translation strategy for improving knowledge and practices pertaining to the timing dialysis initiation.


RESULTS
New research has provided considerable insights regarding the initiation of dialysis. A Canadian cohort study identified significant variation in the estimated glomerular filtration rate level at dialysis initiation, and a survey of providers identified related knowledge gaps that might be amenable to knowledge translation interventions. A recent knowledge synthesis/guideline concluded that early dialysis initiation is costly, and provides no measureable clinical benefits. A systematic knowledge translation intervention including a multifaceted approach may aid in reducing variation in practice and improving the quality of care.


CONCLUSIONS
Utilizing the knowledge-to-action framework, we identified practice variation and key barriers to the optimal timing for dialysis initiation that may be amenable to knowledge translation strategies.
aOttawa Hospital Research Institute (OHRI), Department of Medicine, The Ottawa Hospital, Ottawa bFoothills Hospital, University of Calgary, Calgary cHumber River Hospital dThe Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Canada.
Manish M
MM
Sood
Braden
B
Manns
Gihad
G
Nesrallah
D003661:Decision Support Techniques; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome