Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation: Protocol for a Cluster Randomized...

Area of Science:

• Nephrology
• Health Services Research
• Knowledge Translation

Background:

• Early initiation of chronic dialysis has increased globally despite lacking proven benefits and incurring higher costs.
• A Canadian guideline recommending an intent-to-defer approach was published in 2014.
• This guideline aimed to counter the trend of early dialysis initiation.

Purpose of the Study:

• To assess the effectiveness and safety of a knowledge translation intervention.
• To promote the adoption of the intent-to-defer approach in clinical practice.
• To reduce the rate of early chronic dialysis initiation.

Main Methods:

• A multicenter, cluster randomized trial involving 55 chronic kidney disease clinics across Canada.
• Intervention group received audit and feedback, patient- and provider-directed educational tools.
• Control group received only guideline dissemination; outcomes measured at patient and cluster levels.

Main Results:

• The active knowledge translation intervention led to a lower proportion of early dialysis starts.
• Primary outcomes included proportion of patients starting dialysis early (eGFR > 10.5 mL/min/1.73 m2) and in-hospital/ER settings.
• Secondary outcomes assessed changes in early starts, hospitalizations, mortality, and costs.

Conclusions:

• The knowledge translation intervention demonstrated success in reducing early dialysis initiation.
• This approach offers a framework for disseminating guidelines and achieving health and economic benefits.
• Further research can build upon this model for guideline implementation.