Kidney disease education through Medicare may improve results, but education use declines
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Data presented at ASN Kidney Week demonstrated that although Medicare-reimbursed kidney disease education led to improved outcomes, “few” eligible patients received it and receipt declined during the study period.
“The Centers for Medicare & Medicaid Services initiated a new kidney disease education benefit in 2010 to ensure that beneficiaries with stage 4 [chronic kidney disease] CKD are informed about transplantation, dialysis modalities, vascular access and other issues,” Kirsten L. Johansen, MD, FASN, of Hennepin Healthcare, said in a virtual presentation.
According to Johansen, following the 2019 executive order on Advancing American Kidney Health, the new payment models being developed by CMS (which are to be implemented in the next year) will expand the benefit to patients with stage 5 CKD and those within 6 months of dialysis initiation.
To better understand how kidney disease education is currently utilized and its associated outcomes, Johansen and colleagues included a cohort of adults aged 67 years or older who initiated treatment for end-stage kidney disease in the United States between 2013 and 2017 (n = 106, 456). For the comparison, each patient who received kidney disease education was matched to four patients who did not receive the education.
The researchers found 3% of the cohort received kidney disease education and most of these patients received one session (55.9% vs. 1.2% who received seven or more).
“Somewhat to our surprise, receipt of kidney disease education was declining over that time period rather than increasing, starting at 3.5% of the cohort in 2013 down to 2.5% by 2017,” Johansen added.
Further, the researchers identified specific factors associated with receipt of the benefit, noting older patients were less likely to receive the education than younger patients, as were patients with heart failure.
Regarding outcomes, Johansen and colleagues observed that receipt of kidney disease education was associated with a greater likelihood of initiating kidney replacement therapy on a home-based modality (18% vs. 11.5%). They also found more patients who received kidney disease education started dialysis with a fistula or graft, and fewer with a catheter, than those who did not receive the education. Transplant waitlisting pre-dialysis was 4% for patients who received kidney disease education compared with 2.9% for those who did not get the education.
Johansen acknowledged these associations are not necessarily causal. In other words, she said, more informed patients or those who are more interested in home dialysis may seek kidney disease education and also be more likely to complete the program and vascular access procedures.
“Also, we only studied those patients who reached ESKD, so we couldn’t look at whether education was associated with delay in dialysis start or anything about conservative care,” she added.
Still, Johansen said further investigations should be conducted to look at how expanding kidney disease education could improve outcomes for patients.
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Johansen KL, et al. Paper FR-OR11. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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