‘It's about what I'm able to do’: Using the capabilities approach to understand the relationship between quality of life and vascular access in patients with end-stage kidney failure

KRT comprises three main modalities they are as... kidney transplantation, hemodialysis (HD; home or in-center), or peritoneal dialysis (PD). Globally, access to KRT is influenced by prevailing healthcare infrastructure and funding, and access to treatment varies; the proportion of people with ESKF not receiving KRT is significantly higher in low (96%), and lower-middle (90%) income countries compared to upper-middle (70%) and high-income countries (40%). An estimated 80% of those receiving KRT will undergo HD in-center, with regional variation observed in New Zealand.

In the UK, 68,111 adults and 832 children received KRT in 2019  over half received a transplant (56.8%), while over one-third (35.8%) had HD in-center, 2% had home HD, and 5.4% received PD. Approximately 61% of this population are male, while in terms of ethnicity, three-quarters identify as White, 14.5% as Asian, and 8.9% as Black. . While this access is theoretically universal in the UK via the National Health Service, variation is observed and stratified by race, socioeconomic status, and underlying comorbidity.

While awaiting transplantation, most people opt for hemodialysis, where blood is removed and passed through a dialysis machine to remove waste, electrolytes, and excess fluid before being returned to the body. Patients typically dialyze in a dialysis unit for 4 ​hours, three times a week. To enable hemodialysis, patients must have a form of ‘vascular access (VA) with three options regularly used in the UK:

i.

Arteriovenous fistula (AFV/fistula): surgically created by joining a vein to an artery in the arm that enlarges over time. While offering the longest-lasting and lowest infection risk for dialysis, fistula operations have a success rate of only 50%, and often need several interventions.

ii.

Arteriovenous graft (AVG/graft): synthetic tube surgically inserted in the arm or leg, joining an artery and vein, where needles can be inserted (cannulated) for dialysis. While nearly always successful, grafts require more intervention to maintain function and have more limited durability.

iii.

Central Venous Catheter (CVC/line): plastic tubes inserted through the skin surface, tunneled under the skin, and then passed into a large vein in the neck. Although lines do not require needling to allow dialysis, 20–50% require replacement within the first six months, have the highest rate of serious infection, and can lead to long-term scarring of the central draining veins which is difficult to treat.

Whilst it is well recognized that significant underlying disease and the state of kidney failure can affect well-being, it is less understood how the widely varying modality of vascular access specifically impacts well-being. For most requiring KRT, treatment is supportive rather than curative, thus making the impact on quality of life an essential determinant in selecting vascular access modality.

• As...prevalence rates of End-Stage Kidney Failure (ESKF) have risen across the world in recent years, making it one of the most common chronic illnesses.
• The main treatment for ESKF is hemodialysis, where one is ‘connected’ to a dialysis machine to clean and filter the blood via a surgically-created portal, which is also known as ‘vascular access. Without even functioning vascular access, dialysis is impossible.
• People with ESKF have different experiences with their access modalities, but also universally describe their access point as a ‘lifeline’.
• Previous research has emphasized its impact on well-being specifically on short- and long-term outcomes.
• Capturing Quality of Life (QoL) within ESKF populations has traditionally focused on assessing well-being from an objective, normative, top-down stance, rather than appreciating the nuanced effect vascular access can have as experienced by those living with kidney failure.
• In this article, we have argued current QoL measures used with ESKF groups are insufficient at capturing the impact of vascular access on wellbeing.

This research sought to explore the relationship between vascular access and the Quality of Life of patients with ESKF in the UK. In this paper, we make the case for why current ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;">QoL measures are insufficient and do not fully encapsulate the experience of living with ESKF. Evidence is used gathered through interviews to demonstrate the value of adopting Nussbaum's Capabilities Approach in formulating a better understanding of the quality of life for those with ESKF.