A GRAVER1 M ODELL2, L CHURILOV3, DA POWER1,3,4, PF MOUNT1,3,4, M DAVIES1, SW CHOY1, K PAIZIS1, N COOK1
1Department of Nephrology, Austin Health, Heidelberg, Australia, 2Victorian Institute of Forensic Medicine, Melbourne, Australia, 3Department of Medicine (Austin Health), Melbourne Medical School, University of Melbourne, Melbourne, Australia, 4Kidney Laboratory, Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
Aim: To estimate the proportion of dialysis patients who were driving and those at risk of driving impairment, and to investigate the association between objective and subjective measures of risk.
Background: Driving is a complex task requiring processing of sensory inputs by multiple cognitive domains, to produce musculoskeletal actions that control a vehicle within a dynamic environment. Cognitive dysfunction in the elderly is associated with driving impairment. Dialysis patients have a high prevalence of cognitive impairment and other comorbidities, and may be at risk of driving impairment. No Australian guidelines address driving safety in dialysis patients.
Methods: This single centre study involved voluntary completion of two questionnaires by dialysis patients. The first questionnaire, adapted from a survey developed by Vats and Duffy in 2010, focused on objective markers. The second questionnaire, adapted from the American Medical Association’s “Am I A Safe Driver?” checklist, examined subjective driving experiences. Risk of driving impairment was determined using pre-specified criteria.
Results: 44.8% (99/221) of patients participated; 76.8% (76/99) of participants were driving, and 76.3% (58/76) of drivers were at risk of driving impairment. Factors associated with at-risk driving included post dialysis dizziness, leg weakness or numbness, falling asleep whilst driving, and hypoglycaemia. Sixteen patients had been involved in collisions since commencing dialysis. The questionnaires displayed poor agreement (55.7%, kappa = 0.2028, p=0.047).
Conclusions: Dialysis patients are at risk of driving impairment based on self-reported survey responses. Discrepancies between patients’ perceptions and objective markers were apparent. Further research into appropriate risk assessments, as well as development of guidelines to aid clinicians and licensing authorities to determine driving safety in dialysis patients, is needed.
Dr Alison Graver graduated from the University of Tasmania in 2012, and completed advanced training in adult nephrology (FRACP) at Austin Health in 2019. She currently practises in general and transplant nephrology at Austin Health, and is undertaking a PhD through the University of Melbourne, examining non-invasive monitoring of kidney transplant recipients. Her areas of interest include renal transplantation, epidemiology, public health and supportive care.