| Summary: | Worldwide, dialysis therapies have become the mainstay of renal replacement therapy for end-stage renal disease (ESRD). Mortality rates in individuals with ESRD are 10-100 times higher than age-matched controls with normal kidney function. Dialysis was originally developed as a transition therapy from acute kidney injury to renal recovery. In the modern day era of chronic dialysis therapy only two factors have been shown to improve survival; the use of an arteriovenous fistula (AVF) for haemodialysis and more frequent dialysis (which due to economic reasons, can only be achieved at home in the majority of settings) compared to conventional in-hospital three times weekly 4 hour sessions. Unfortunately, 30-50% of AVFs fail to mature sufficiently to be usable for haemodialysis largely for unknown reasons. The uptake of home dialysis therapies is very low world-wide despite apparent physician enthusiasm. This thesis explores the role of clinical factors, pre-operative ultrasound mapping parameters and arterial stiffness in predicting AVF failure to mature in a Northern Ireland cohort of individuals. It also investigates differences in psychological traits in pre-dialysis, in-centre/hospital based dialysis and self-care dialysis patients (in-centre self-care dialysis, home haemodialysis and peritoneal dialysis) which may affect decision making with regard to the selection of renal replacement therapy modality. These traits are anxiety, depression, self-efficacy, perceived social support and optimism. The relationship between these traits and satisfaction with vascular access is also examined. Personality traits have been linked with job performance in a number of medical specialties. This research project goes on to investigate the association between consultant nephrologist personality traits and optimal patient outcomes with regard to renal replacement therapy (transplantation, home dialysis, and work up for AVF creation) in a single centre.
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