Educational intervention improved dialysis decision-making in veterans with advanced CKD
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Key takeaways:
- Health literacy, stage 5 kidney disease and hypertension were linked to replacement therapy.
- After intervention, 94.5% of patients were able to state their kidney replacement therapy preference.
SAN DIEGO — An educational intervention improved dialysis decision-making in veterans with advanced chronic kidney disease, according to data presented at Kidney Week.
Researchers led by Anuradha Wadhwa, MD, a nephrologist at the Edward Hines Junior VA Hospital in Hines, Illinois, conducted a prospective cohort study of five Veteran Healthcare systems in Florida, Utah and Illinois. The goal was to assess the effect of the comprehensive pre-dialysis education program on decision-making regarding kidney replacement therapy (KRT).
“What we are trying to do here is figure out ... if we are suggesting a lot of people should do home dialysis [and if] patients are really interested,” researcher Ashutosh M. Shukla, MD, of the VA North Florida South Georgia Veterans Health System in Gainesville, Florida, told Healio. “It is very important because it is the patients who are supposed to choose this. if most people are not able to select, what are the things that predict their decision-making capacity?”
The study included 218 veterans in rural areas and who had comprehensive pre-dialysis education from 2023 to 2024. An informed modality selection was defined as KRT with more than 60% confidence on a 0% to 100% scale.
Researchers assessed decision-making gaps before and after comprehensive pre-dialysis education considering patient characteristics.
Prior to the intervention, 9% of veterans reported having decision-making support and 9% had comprehensive pre-dialysis education, according to the findings. Before comprehensive pre-dialysis education, 38.5% if patients were able to endorse a hypothetical KRT modality. After intervention, 94.5% were able to express a KRT preference.
The preference for home dialysis among the cohort increased from 21% pre-comprehensive pre-dialysis education to 82% after the education, Shukla and colleagues found.
The researchers identified key factors influencing decision-making before intervention. Optimal health literacy, stage 5 CKD and hypertension were linked to higher odds of choosing KRT. Post-intervention, selecting a therapy modality was solely influenced by patients’ awareness of CKD and end-stage kidney disease.
Veterans’ selection confidence improved after the intervention, the researchers found.
Shukla said system-wide implementation of educational interventions may benefit veteran confidence in dialysis options and increase home dialysis.
“We need to do a better job providing patients education so they can reach higher-quality decisions, more decisions and, because of that, gain the knowledge about what dialysis is,” Shukla said.”
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Wadhwa A, et al. TH-PO315. Presented at: ASN Kidney Week; Oct. 24-27, 2024; San Diego.
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