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Patient Referral and Education Program Prior to Renal Replacement Therapy (PREP-RRT): A Pilot Study
Milda R Saunders1, Lindsay Zasadzinski2, Cynthia Gaspard2
1General Internal Medicine, University of Chicago Medicine, Chicago, IL, USA. msaunders@uchicago.edu.
Insights
A brief hospital intervention significantly improved Chronic Kidney Disease (CKD) knowledge in African American patients. This study highlights the need for tailored education to enhance understanding of kidney disease and treatment options.
Area of Science:
- Nephrology
- Public Health
- Health Disparities
Background:
- African Americans with Chronic Kidney Disease (CKD) face disparities in early education and care, leading to faster progression to kidney failure.
- Timely and culturally relevant CKD education is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a brief inpatient intervention in increasing CKD knowledge among African American patients.
- To assess the impact of the intervention on patient understanding of kidney failure treatment options.
Main Methods:
- A pilot study (PREP-RRT) involving hospitalized African American adults with estimated glomerular filtration rate (GFR) ≤45.
- Intervention included social worker-led CKD education and motivational interviewing for behavior change.
- Pre- and post-intervention assessments used the Kidney Knowledge Survey (KiKS) to measure changes in CKD knowledge.
Main Results:
- Only 45% of participants had adequate CKD knowledge at baseline.
- The intervention led to a statistically significant improvement in CKD knowledge scores (p < 0.001).
- Knowledge of kidney failure treatment modalities significantly increased, although intent for lifestyle changes remained unchanged.
Conclusions:
- A brief, culturally tailored inpatient intervention effectively enhanced CKD and kidney failure treatment knowledge in African American patients.
- Further research is needed to develop intensive interventions that sustain knowledge and promote lifestyle modifications.
Background:
African American individuals with CKD are less likely to receive early CKD education and care than their White counterparts and have a more rapid progression to kidney failure.
Objective:
To determine if a brief inpatient intervention increased CKD knowledge.
Design:
Pre-post evaluation of a pilot intervention.
Participants:
The PREP-RRT pilot study recruited hospitalized adult African American patients with an estimated glomerular filtration rate (GFR) ≤ 45 from a general medicine inpatient service at a Midwestern academic medical center.
Interventions:
A social worker provided CKD patient education and motivational interviewing for behavior change.
Main Measures:
The primary outcome was change in patient knowledge about CKD, using the Kidney Knowledge Survey (KiKS), and kidney failure treatment options.
Key Results:
Out of the 60 patients, 52% were female (n = 21) with a mean age of 61 years old (range 28-76). Only 45% of patients (n = 27) had sufficient CKD knowledge at baseline. The median pre-intervention CKD knowledge score was 16 (interquartile range (IQR) 13-18) and the post-intervention score was 19 (IQR 17-21). Paired t-tests showed significant improvement in the primary outcome, CKD knowledge (p < 0.001). Overall baseline knowledge of kidney failure treatment modalities was low (< 30% with some to great knowledge for all modalities), and participants reported a significant increase in knowledge across kidney failure treatment modalities (all p < 0.05 except p = 0.17 conservative management). Patient intent to make lifestyle changes was high pre-intervention and did not change significantly.
Conclusions:
A brief, culturally tailored inpatient intervention successfully increased knowledge of CKD and kidney failure treatment options for African American hospitalized patients. More intensive interventions are needed to sustain knowledge gains and motivation for lifestyle changes.
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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...