Peoples Perceptions of Forms of Renal Replacement Therapy
Peoples Perceptions of Forms of Renal Replacement Therapy
Chronic kidney disease (CKD) causes symptoms and potential loss of independence. These
 effects are increased as the disease progress to endstage renal disease (ESRD), particularly
 when external intervention (i.e.

 dialysis) is used to keep these individuals alive. The combined effect of ESRD and its
 treatment has a significant impact on an individual's life, potentially causing reduced
 employment time, reduced social time and increased anxiety/stress.

 The purpose of this study is to investigate the impact that CKD/ESRD have on an individual's
 life. Specifically, this study is focused on giving an insight into the psychosocial impact
 that CKD/ESRD and different forms of renal replacement therapy have upon these individuals.
Chronic kidney disease (CKD) affects over 4% of the UK population, with approximately 118 per
 million population commencing treatment for end-stage kidney disease each year (UK renal
 registry, 2017). As enal function deteriorates, these individuals become progressively
 symptomatic and require renal replacement therapy (RRT). CKD is split into five stages,
 classified by their glomerular filtration rate (eGFR), with stages G4 and G5 representing
 advanced disease preceding end-stage renal failure (Levey et al., 2005).

 Along with diminished physical ability, cognitive function and quality of life (QoL) have
 also been shown to deteriorate within this population (Abdel-Kader, Unruh, & Weisbord, 2009).

 Previous findings have shown that individuals with renal disease, particularly advanced
 CKD/ESRD have a reduced QoL and substantial symptom burden, defined as a loss of functional
 abilities along with psychological suffering affected by the impact of their symptoms (Gill,
 Chakraborty, & Selby, 2012). Of note, this seems to become particularly notable at the
 initiation of RRT (Pagels, Söderkvist, Medin, Hylander, & Heiwe, 2012). This supports
 previous findings by Davison & Jhangri (2010) and findings by Lowney et al (2015) who found
 that individuals undergoing in-centre haemodialysis (HD) had a substantial symptom burden
 which was associated with a reduced health-related QoL. This is significant because in-centre
 HD (ICHD) is currently the most common form of RRT globally.

 To date, no research has qualitatively examined the burden of other forms of RRT, such as
 home haemodialysis (HHD), which is typically undertaken at home more frequently and for
 shorter durations than ICHD; and peritoneal dialysis (PD), where the peritoneum is used as a
 membrane through which excess fluid and toxins are removed from the body. A recent
 investigation by Jones and colleagues (2018) explored the perceptions of UK-based individuals
 undergoing ICHD within the National Health Service (NHS). Interestingly, several common
 themes were identified; including fluctuations in their QoL and well-being over the course of
 their HD therapy and restrictions in their social lives, due to HD scheduling and the heavy
 emotional impact on themselves and others. These were shown to often be overlooked in the
 literature, however, these factors have the potential to negatively impact an individual's
 QoL and sense of self, defined as one's sense of purpose in life. Importantly, higher rates
 of depression and anxiety have also been reported in individuals with CKD (Chen et al., 2010;
 Semaan, Noureddine, & Farhood, 2018). For example, Barros et al. (2016) found that greater
 than 30% of individuals had depressive symptoms and reduced QoL. Furthermore, those found
 with depressive symptoms tended to have a lower survival rate at the 2-year evaluation
 period. It has been postulated that this increased prevalence in depressive symptoms could be
 due to some significant psychosocial implications of CKD such as, reductions in employment,
 social and personal time and interpersonal relationships (Finnegan-John & Thomas, 2013),
 supported by a recent (currently unpublished) investigation conducted by the research team
 for this study at the Wessex Kidney Centre (WKC). During this study, it became clear through
 informal discussions with people with ESRD and the treatment of this impacts their lives
 greatly and that qualitative markers of QoL had the potential to be very insightful into the
 impact of ESRD. Given the above, this study aims to investigate the QoL of adults at the
 advanced stages of CKD (CKD stage G4 and G5) and those on all modalities of RRT (ICHD, HHD,
 PD, and transplantation).
Inclusion Criteria:

 Aged 18 years or older Willing and able to undertake the interview process Able to give
 informed consent

 Exclusion Criteria:

 Age < 18 years Does not provide written informed consent Any neurological/psychiatric
 diagnoses Lack of fluency in English Individuals who have commenced RRT within three months
 of the study start date Transplant patients being seen in clinic more than once every
 fortnight