When utilized, education about modalities led more patients to home dialysis

Kristine Kubisiak

DALLAS — The Kidney Disease Education Benefit, introduced in 2010, has information that can help patients with CKD decide about treatment options when they reach ESKD. A study presented at the Annual Dialysis Conference here showed that, when utilized by the kidney care team, the Kidney Disease Education Benefit often leads patients to choose home dialysis.

“In this study, we were looking at the KDE Benefit as a tool for increasing home dialysis adoption and we did see a relatively high number [of patients] transition to home dialysis,” Kristine Kubisiak, MS, a co-author on the study, told Healio/Nephrology.

The Medicare Improvements for Patients and Providers Act of 2008 added KDE as a Medicare-covered service for patients with stage 4 CKD. A physician, physician’s assistant or nurse practitioner can administer the education benefit, but not a dialysis facility.

Kubisiak and colleagues from NxStage Medical analyzed Medicare data that included outpatient facility claims and physician claims from 2014 to 2016 to identify patients who received at least one KDE session between Jan. 1, 2014 and Sept. 30, 2016. Patients were followed until Dec. 31, 2016. Among patients received the benefit, researchers identified any use of outpatient dialysis after the last KDE session and recorded the location — home or in-center — of each dialysis treatment.

After identifying 667 patients who received KDE, Kubisiak and colleagues noted that only 150 progressed to dialysis initiation. In that group, there was a median of 5.4 months between the last KDE session and first outpatient dialysis treatment. Among those who progressed to dialysis initiation, home dialysis was the first setting for 30 patients. Another six patients dialyzed at home within 3 months after dialysis initiation.

“We did see 30 patients of 150 patients decide to dialyze at home,” Kubisiak told Healio/Nephrology. “That seemed to be a fairly effective method for patients to see all modality options, but we do believe it is underutilized.

“That a small share of KDE recipients progressed to dialysis initiation may indicate a mismatch between benefit eligibility criterion (CKD-4) and real-world applicability," Kubisiak and colleagues wrote. “Nevertheless, further analysis of the KDE in the entire Medicare Part B beneficiary population with CKD is needed.” - by Mark Neumann

Reference:

Weinhandl E, et al. The kidney disease education benefit and home dialysis utilization. Presented at the Annual Dialysis Conference; March 16-19, 2019; Dallas.

Disclosures: Weinhandl and Kubisiak report no relevant financial disclosures.