Abstract: SA-PO029
Effect of Renal Replacement Therapy Options Education Class on Patient Outcomes
Session Information
- Educational Research
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 800 Educational Research
Authors
- Pravoverov, Leonid, Kaiser Permanente, Walnut Creek, California, United States
- Zheng, Sijie, The Permanente Medical Group, Oakland, California, United States
Background
Transition from CKD into ESRD is a traumatic and often uncoordinated process. Many patients “crash landing” into hemodialysis with a central venous catheter. Structured CKD care can better prepare patients for transition to ESRD. Yet, it has not been systematically implemented nationally due to fragmented care outside of integrated health care systems, lack of patient awareness or engagement regarding CKD issues. Kaiser Permanente East Bay Nephrology Group implemented patient education program delivered by renal RN’s to provide patients and family education on RRT modalities with the goal of providing smoother transition into ESRD.
Methods
KP East Bay implemented a standardized RRT option class for patients with CKD stage 4 and 5. It was highly recommended to be completed when a patient’s eGFR reaches 20ml/min or below. It was taught by a renal nurse. The class last average 1-2 hours. It was attended by a patient and family members. The nurse discussed different type of RRT options, including: conservative management without dialysis (CMWD), kidney transplant, in-center hemodialysis (HD) and home dialysis (PD and HHD).
Results
Since the initiation of new Options Class in 2016, 460 patients have attended it. The average creatinine at the time of referral was 3.58 mg/dl and average eGFR was 18.71 ml/min. After the option class, 43.3% patients chose home therapy: 37.3% chose PD and 5.4% chose HHD. 26.5% chose ICHD, 3% chose CMWD. 31% remained undecided on their care plan after attending option class. As of 2019, 86 (11.7%) patients who attended Options education initiated dialysis. Among them 53.2% on home dialysis (50% with PD; 2.3% with HHD); 47.6% with ICHD, 2.3% received a pre-emptive transplant. 29% expired before dialysis initiation and 59.3% remained dialysis independent.
Conclusion
A structured RRT option class resulted in a smoother transition into RRT with higher percentage of patients chose home modality. Further work needs to be done to improve targeted interventions to guide patients who have difficulties to formulate decision or ESKD Life Plan. Comparison of characteristics of patients who attended the classes versus those who did not, as well as details of outcomes of patients remaining with CKD and those who died before reaching RRT need to be studies to confirm and quantitate benefits of this educational program.