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Effects of a Knowledge-Translation Intervention on Early Dialysis Initiation: A Cluster Randomized Trial
Navdeep Tangri1,2, Amit X Garg3,4,5, Thomas W Ferguson1,2
1Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada.
Journal of the American Society of Nephrology : JASN
|April 16, 2021
Summary
A knowledge translation intervention did not reduce early dialysis initiation in patients with chronic kidney disease (CKD). The study found no difference in early or acute inpatient dialysis starts between intervention and control groups.
Area of Science:
- Nephrology
- Public Health
- Knowledge Translation
Background:
- The 2009 IDEAL trial indicated no benefit to early dialysis initiation, leading to "intent-to-defer" guidelines.
- Guidelines now recommend delaying dialysis until symptomatic to avoid potential harms.
Purpose of the Study:
- To assess a knowledge translation intervention's effectiveness in promoting an "intent-to-defer" dialysis strategy.
- To reduce the proportion of patients initiating dialysis prematurely.
Main Methods:
- A cluster randomized trial involving 55 Canadian clinics (27 intervention, 28 control).
- The intervention included audits, guideline delivery, academic detailing, and broker calls.
- 3424 adult patients initiating dialysis within one year post-intervention were analyzed.
Main Results:
- No significant difference in early dialysis initiation (eGFR >10.5 ml/min/1.73 m²) between the intervention (32.0%) and control (33.0%) groups.
- The intervention also did not reduce the proportion of patients starting dialysis as acute inpatients.
Conclusions:
- A multifaceted knowledge translation intervention was ineffective in reducing early dialysis initiation.
- Current strategies may not be sufficient to shift clinical practice towards deferring dialysis in CKD patients.
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