Exploring the Factors Influencing the Translation of Dialysis Interventions into Clinical Practice: Focus on the Implementation of In-centre Nocturnal Haemodialysis.

Individuals receiving dialysis have increased mortality rates compared to other non-communicable chronic disease cohorts. They also experience co-morbidity, hospitalisation, and poor health-related quality of life. The evidence-base to clinical-practice gap is an important contributing factor for the worsening impact of kidney disease.This thesis explores the translation of dialysis research into clinical practice and the implementation of complex interventions through a mixed methods approach. The non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework and the implementation of in-centre nocturnal haemodialysis (INHD) as part of the NightLife study (ISRCTN87042063) have been used to develop this thesis.A systematic review demonstrated that many randomised controlled trials in the dialysis population are not utilised in clinical guidelines and this may be associated with poor study design, inconsistent reporting and lack of external validity. North American research is more likely to be utilised, the peritoneal dialysis population are poorly represented, and there has been an absence of documented Patient and Public Involvement and Engagement. A qualitative content analysis demonstrated commonality in the challenges to dialysis service innovation across UK dialysis units. Four themes were identified that contributed to both the adoption and non-adoption of INHD: inequity; role of knowledge and evidence; staff perception and experience; resources, support and complexity. Vascular access safety has frequently been raised as a concern by the dialysis community when considering INHD. A retrospective cohort study from dialysis centres in the UK, Canada and Netherlands demonstrated there does not appear to be an increased risk to vascular access survival and safety for INHD compared to daytime haemodialysis.The findings of this thesis are the first to explore the factors that may influence the translation of dialysis research findings into clinical practice. These findings provide strong foundations for future lines of inquiry and offer practical implications for research and clinical practice.