Related Experiment Video
Updated: Sep 5, 2025
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Utilization of Home Dialysis and Permanent Vascular Access at Dialysis Initiation Following a Structured CKD
Katherine Mckeon1, Scott Sibbel1, Steven M Brunelli1
1DaVita Clinical Research, Minneapolis, MN.
Insights
Structured education before dialysis initiation significantly improves patient outcomes. Attending a CKD education class leads to more home dialysis use and fewer hospitalizations and deaths.
Area of Science:
- Nephrology
- Public Health
- Patient Education
Background:
- Patients starting dialysis often lack information on treatment options, leading to suboptimal choices like in-center hemodialysis via central venous catheter.
- This default pathway is associated with high rates of hospital admissions, mortality, and infections in the initial months of dialysis.
Purpose of the Study:
- To evaluate the impact of a structured Chronic Kidney Disease (CKD) education program on patient decision-making and clinical outcomes before dialysis initiation.
- To determine if CKD education influences dialysis modality, vascular access, hospitalization, and mortality rates.
Main Methods:
- A matched retrospective cohort study involving 2,398 adult patients with CKD.
- Patients were divided into two groups: those who attended a 1-time CKD education class and a control group who did not.
- Outcomes including dialysis modality, vascular access, hospitalizations, and mortality were compared between groups using generalized linear models.
Main Results:
- CKD education patients were significantly more likely to start home dialysis (38.5% vs. 12.6%) and use permanent vascular access (57.9% vs. 33.8%) compared to controls.
- Hospitalization rates were lower in the education group during the first year of dialysis (1.00 vs. 1.38 admissions per patient-year).
- Mortality rates were also significantly lower in the CKD education group within the first year.
Conclusions:
- Attending a structured CKD education class prior to dialysis initiation is associated with improved clinical outcomes, including reduced hospitalizations and mortality.
- Widespread implementation of CKD education programs can empower patients to choose home dialysis and mitigate adverse events during the critical early phase of dialysis treatment.
Rationale & Objective:
Treatment options for kidney failure are complex, and the majority of patients transitioning to dialysis lack important information about treatment options and are not prepared to make informed decisions about their care. Correspondingly, the majority of patients who start dialysis default to in-center hemodialysis using a central venous catheter for vascular access as the initial modality; furthermore, hospital admissions, mortality, and infections are exceedingly common over the first few months.
Study Design:
Matched retrospective cohort study.
Setting & Patients:
2,398 adult patients with chronic kidney disease (CKD) who attended a structured CKD education program and pair-matched control patients who did not receive education before starting dialysis between January 2018 and June 2019.
Exposure:
CKD education attendance documented from 2 months (60 days)-3 years before dialysis initiation. CKD education consisted of a 1-time, 90-minute, inperson or virtual class.
Outcome:
Primary outcomes were dialysis modality and vascular access type on the first day of dialysis (day 0) and at day 90 after dialysis initiation. Secondary outcomes included hospitalizations and deaths during the first year of receiving dialysis.
Analytical Approach:
Generalized linear models were used to compare outcomes between patients receiving CKD education and controls.
Results:
Compared with controls, CKD education patients were more frequently receiving home dialysis (38.5% vs 12.6%, P < 0.001) and used a permanent vascular access (57.9% vs 33.8%, P < 0.001) at dialysis initiation; differences were minimally attenuated and remained statistically significant at day 90. Hospitalization rates were lower among CKD education patients than among controls during the first year of receiving dialysis (1.00 vs 1.38 admissions per patient-year; P < 0.001). CKD education patients also had lower mortality over the first year of receiving dialysis (P < 0.001).
Limitations:
Bias and confounding cannot fully be accounted for in an observational study. Analyses only included patients with commercial and Medicare insurance who received CKD care before dialysis initiation and may not be generalizable to other patient populations.
Conclusions:
Our findings indicate that attending a CKD education class before starting dialysis resulted in positive clinical outcomes, including reduction in hospitalization and mortality rates. Broad implementation of structured CKD education may result in more patients choosing home dialysis as their first treatment option and reduce the risk of adverse outcomes in the crucial early period after dialysis initiation.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:28Chronic Kidney Disease III: Interprofessional Care
01:20Acute Kidney Injury V: Interprofessional Care