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Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment
Gajapathiraju Chamarthi1, Tatiana Orozco2, Jennifer Hale-Gallardo3
1Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, Florida.
Kidney Medicine
|June 14, 2024
Summary
Veterans with advanced chronic kidney disease (CKD) show poor awareness of their condition
Area of Science:
- Nephrology
- Public Health
- Health Services Research
Background:
- The Advancing Americans Kidney Health Executive Order promotes home dialysis for kidney replacement therapy (KRT).
- Informed KRT modality selection requires predialysis nephrology care and comprehensive pre-kidney failure patient education (CoPE).
- The status of these services and patient preferences for home dialysis in advanced CKD are largely unknown.
Purpose of the Study:
- To assess the availability of predialysis nephrology care and KRT-directed education among Veterans with advanced CKD.
- To evaluate Veterans' awareness of CKD severity and their decision-making capacity for KRT modality selection.
- To identify gaps in patient education and care essential for informed home dialysis choices.
Main Methods:
- A community-based, cross-sectional observational cohort study was conducted in a large regional Veteran Healthcare System.
- 928 Veterans with advanced CKD (eGFR <30 mL/min/1.73 m²) were identified; a random cohort was invited for needs assessment.
- Data collected included current nephrology care, KRT-directed education receipt, and KRT modality preferences.
Main Results:
- Awareness of kidney disease was high (92.2%), but awareness of CKD severity was low (38.5%).
- Only 46.8% received KRT-directed education, with 21.1% attending targeted CoPE classes; 74.3% desired CoPE.
- Decision-making for KRT modality was poor; 73.8% could not select any modality, and only 13% felt confident choosing home KRT.
Conclusions:
- Awareness of kidney disease is linked to nephrology care, but informed KRT selection remains universally poor among Veterans with advanced CKD.
- A significant gap exists between recommended predialysis care/education and current practices for informed patient-centered home dialysis selection.
- Targeted interventions are needed to improve CKD education and shared decision-making for KRT in this population.
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