Patients who receive CKD education are likely to choose home dialysis at initiation
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Compared with patients who did not receive chronic kidney disease education, those who did were more likely to choose home dialysis and a permanent vascular access at initiation.
“Treatment options for kidney failure are complex, and the majority of patients who develop kidney failure lack important information about treatment options and are not prepared to make informed decisions about their care,” Katherine Mckeon, MSPH, from DaVita Clinical Research in Minnesota, and colleagues wrote. “If CKD education before kidney failure demonstrates a positive impact on patient outcomes, relevant policies should be developed to support broad availability and access to these programs. In the current study, we leveraged the experience from Kidney Smart (DaVita Inc), a structured CKD education class implemented across the United States, to test the association of CKD education with clinical outcomes among patients starting dialysis, with emphasis placed on minimizing biases and confounding.”
In a matched retrospective cohort study, researchers examined 2,398 adult patients with CKD who participated in a CKD education program before dialysis and 2,398 matched individuals who did not receive education before dialysis initiation. All patients initiated dialysis between January 2018 and June 2019.
Kidney Smart is a free education program to kidney patients and caregivers that focuses on CKD diet, lifestyle, comorbid conditions management and treatment options. The program consists of a 90-minute class and additional online resources.
Patients in the intervention group of this study completed the Kidney Smart program from 2 months to 3 years prior to dialysis initiation. Dialysis modality and vascular access type on the first day of dialysis and at day 90 after dialysis initiation served as primary outcomes.
Researchers utilized generalized linear models to compare outcomes between patients who attended Kidney Smart and those who did not.
Analyses revealed 38.5% of patients receiving CKD education underwent home dialysis and 57.9% used a permanent vascular access at dialysis initiation. In comparison, 12.6% of those who did not receive education underwent home dialysis and 33.8% used a permanent vascular access at dialysis initiation. The differences between groups remained statistically significant at day 90 of dialysis.
Similarly, patients who received CKD education experienced fewer hospitalizations and lower mortality during the first year on dialysis than those who did not receive education.
“In this analysis, a structured CKD education program was associated with improved clinical outcomes in the critical early period after dialysis initiation among patients who received CKD care before dialysis initiation,” McKeon and colleagues wrote. They added, “Novel approaches are needed to ensure that all patients with advanced CKD have access to predialysis education and ensure broad implementation of structured programs.”
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