Table 3.

Symptom-specific strategic action plans for top-prioritized research goals

Goals	Actions	Potential Challengesa	Solutions	Timeframe, yr
Insomnia
Test CBT and explore integration of exercise with CBT	Conduct clinical trial	CBT adaptation to dialysis setting	Expert, interdisciplinary clinical team	4–5
		Provider buy-in	Provider outreach to facilitate implementation and promote sustainability
		Exercising in dialysis clinic	Patient outreach, local champions
		Exercising at home
Test effectiveness of site-specific insomnia protocols including online CBT and CBT adapted for dialysis	Perform provider outreach	Health literacy of patients	Simple, accessible protocols that incorporate patient input	3–5
	Develop algorithms	Internet access, tablet availability	Patient outreach, local champions
	Develop infrastructure for treatment delivery	Patient adherence	Dialysis organization outreach
	Test online CBT for hemodialysis	Dialysis personnel and provider buy-in	Tablet manufacturer outreach
Test safety and efficacy of at least one drug for insomnia in patients on dialysis	Select drug	Business risk to pharmaceutical companies	Pharmaceutical industry-independent funding	2–3
	Conduct clinical trial	Contraindications to drugs	Industry outreach
		Unknown patient preferences	Patient outreach, local champions
Muscle cramps
Measure frequency, duration and severity of cramps to characterize problem	Investigate measures from other clinical settings	Lack of existing data	Potential KHI proposal	1
	Develop and pilot test an assessment tool for cramping	Language, cultural differences	Include non-English-speaking patients and patients from different cultural backgrounds
Test acceptability of available, low-risk interventions (e.g., pickle juice, mustard)	Conduct pilot tests	Unknown patient preferences	Patient outreach, local champions	3
		Dialysis personnel buy-in	Dialysis organization outreach
		Lack of experience with agent	Industry partnership
Test effectiveness of treatments	Select most promising interventions from pilot testing for pragmatic clinical trial	Lack of existing data	Patient outreach, local champions	5–7
	Conduct smaller clinical trials that incorporate physiologic measures	Dialysis personnel buy-in	Dialysis organization outreach
Fatigue
Develop a standardized checklist for medical workup	Develop checklist	Need for balancing completeness and feasibility	Engage multidisciplinary partners	1
		High number of potential conditions for screening	Modify evidence-based algorithms from other disciplines
		Cost of work-up	Dialysis organization outreach
		Potential for duplicative testing
		Ownership of findings and subsequent management
Test efficacy of standard of care versus exercise versus exercise plus CBT	Identify exercise approach	Implementation	Align with existing social work and CBT programs at partnered dialysis organizations	3–4
	Develop protocol with patient engagement (consider patient preferences and acceptance)	Sustainability	Early involvement of stakeholders to facilitate implementation and promote sustainability
	Conduct clinical trial	Facility workflows	Expert, interdisciplinary clinical team
		Legal
Explore psychostimulants and assess associated patient preferences and risk tolerance	Develop protocol for PK/PD modeling study	Lack of existing data	Pharmaceutical industry-independent funding	1
	Develop protocol for study assessing patient risk–benefit, tolerance, and preferences	Potential harm	Industry outreach
		Contraindications to drugs	Patient preference and risk tolerance assessment
		Lack of interest from pharmaceutical companies
		Negative effect on sleep

CBT, cognitive–behavioral therapy; KHI, Kidney Health Initiative, PK/PD, pharmacokinetic/pharmacodynamic.

^aFunding and recruitment challenges were common to all three symptoms and are excluded from the table.