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Optimal Education: Paving the Way for True Optimal Start Dialysis
Maria Camila Bermudez1, Ankur D Shah2,3, Osama El Shamy4
1Department of Nephrology, Geisinger Health, Danville, PA.
Kidney Medicine
|December 4, 2025
Summary
Optimal kidney failure education is crucial for patients starting end-stage renal disease treatments. Enhancing patient education across all settings, including inpatient, is vital for achieving optimal starts and improving outcomes.
Area of Science:
- Nephrology
- Medical Education
- Health Policy
Background:
- Optimal End Stage Renal Disease (ESRD) Starts are defined by the Comprehensive Kidney Care Contracting Program.
- These optimal starts, including preemptive transplant, home dialysis, or arteriovenous access for in-center hemodialysis, depend on effective patient education.
- Current education delivery may not align with policy changes making treatment options available regardless of diagnosis or setting.
Purpose of the Study:
- To explore existing gaps in kidney failure modality education delivery.
- To identify successful national and international educational models.
- To propose a roadmap for implementing effective inpatient kidney failure education.
Main Methods:
- Review of current practices in outpatient nephrology clinics, dialysis units, and inpatient settings.
- Analysis of successful national and international kidney failure education programs.
- Identification of the roles of urgent-start peritoneal dialysis and transitional care units.
Main Results:
- Gaps exist in the current delivery of kidney failure modality education.
- Successful models for site-independent and diagnosis-independent education have been identified.
- Urgent-start peritoneal dialysis and transitional care units play a key role in optimizing patient starts.
Conclusions:
- Effective patient education is fundamental for achieving optimal end-stage renal disease starts.
- A coordinated, site-independent, and diagnosis-independent educational approach is needed.
- Implementing an inpatient kidney failure education program can reduce "crash-start" hemodialysis.
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