Frailty is strongly associated with poor health outcomes among patients with advanced chronic kidney disease (CKD). While clear guidelines exist for other chronic disease entities, there is no current consensus on the most appropriate assessment tools or settings in nephrology populations, nor how the presence of frailty should direct nephrology care.

Aim To understand the views and experiences of clinicians caring for patients with advanced CKD with respect to frailty assessment and management.

Method A cross-sectional online survey was undertaken across Australia and New Zealand between October 2020 and December 2020. Participants were asked about frailty assessment and context, as well as management practices.

Results The estimated response rate of 11% included nephrologists (64%), palliative medicine physicians (17%) and geriatricians (7%) caring for patients with advanced CKD. Respondents considered frailty to be a useful concept in evaluating patients with kidney disease (94%) as it influences decisions regarding candidacy for renal replacement therapies (RRT) – dialysis (47%), transplant (51%) – and supports shared decision making and planning of comprehensive care. There is clinical uncertainty about whether frailty is remediable (54%). Responses demonstrated inconsistent use of frailty assessments in clinical practice, with increased utilisation within renal supportive care services and palliative care settings. The most commonly used tools were the Karnofsky Performance Scale (30%) and Surprise Question (28%), with less use of more objective scores such as the Rockwood Clinical Frailty Scale (15%) and Fried Frailty Phenotype (5%). There was widespread support for the development and implementation of accessible frailty assessments in the care of patients with kidney disease.

Conclusions The present study offers insight into frailty practice patterns, highlights potential deficits within systems delivering care, and offers a consensus that clinical assessment of patients with advanced CKD is improved by an understanding of frailty but is currently underutilised.

Research involving people receiving peritoneal dialysis can pose many challenges for researchers. Personal (e.g. mistrust), logistical (e.g. infrequent contact with care team) and organisational (e.g. high workload) barriers have been identified which may dissuade researchers from undertaking work with this population. Consequently, people receiving peritoneal dialysis may miss out on experiencing the research advances seen in other clinical cohorts. It is imperative that investigators work to mitigate such research barriers so that people receiving peritoneal dialysis benefit from advancements in their clinical care. This paper presents highlights, obtained from two projects, of strategies employed and processes undertaken to mitigate barriers and enhance research quality. Both case studies observed a high percentage of the available population recruited and strong stakeholder engagement, suggesting the approach was successful. Successful approaches that were identified include placing an emphasis on building a strong collaboration with relevant stakeholders, facilitating effective communication, utilising digital and written resources, and providing patients with flexibility within the study protocol.

The field of nephrology has changed considerably over the past 40 years. Contemporary standard care follows a period of remarkable growth and transformation. As the prevalence and complexity of patients with kidney disease continues to increase, simpler times and practices are easily forgotten. Awareness of how far medicine has come allows physicians to provide thoughtful and contextualised care, and gives direction for the future. Through this article we reflect on our personal and professional experiences to highlight changes in the everyday practice of nephrology in Queensland, Australia, across 4 decades from 1980 till now.

Introduction New Zealand’s Asian population is growing and diverse. Kidney failure is a major health burden and 10% of dialysis population is identified as Asian ethnicity. There is currently no information about their experience on haemodialysis. This study aimed to understand their perspectives in order to help improve dialysis experience.

Methods Thirteen Asian haemodialysis patients were recruited and took part in semi-structured interviews in Counties Manukau Health. All interviews were recorded, transcribed and reviewed. Themes were developed based on common experiences.

Findings Four key themes emerged from the data – the impact of illness, how culture and language are integral to health, the importance of family, and personal relationships with health professionals. Some experiences were associated with being on dialysis and their overall health status and the major time commitment associated with dialysis visits. Others were related more specifically to cultural factors, including reliance on support from extended family, and access to familiar food. Language barriers were also an important factor, especially for the participants living in aged care facilities. All the participants highly valued the input from dietitians, doctors and staff from dialysis units.

Discussion Asian dialysis patients face a range of challenges on dialysis. Particular challenges included language difficulties and accessing cultural support. Developing an increasingly culturally and linguistically diverse workforce could lead to improved care of this population.