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Abstract: SA-PO837

Impact of a Virtual Multidisciplinary Care Management Program for Advanced CKD on Patient Knowledge, Dialysis Modality Choice, and Planned Dialysis Start

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Peralta, Carmen A., Cricket Health, UCSF, San Francisco, California, United States
  • Kaiser, Paulina, Samaritan Health Services, Corvallis, Oregon, United States
  • Pipitone, Olivia, Samaritan Health Services, Corvallis, Oregon, United States
  • Jackson, Dixie R., Samaritan Health Services, Corvallis, Oregon, United States
  • Franklin, Anthony, Samaritan Health Services, Corvallis, Oregon, United States
  • Dubuque, Chris R., Good Samaritan Regional Medical Center, Grants Pass, Oregon, United States
  • Moore, Elizabeth A., Samaritan Health Services, Corvallis, Oregon, United States
  • DeMory, Anthony C., Samaritan Kidney Specialists, Corvallis, Oregon, United States
Background

Among persons with advanced chronic kidney disease (CKD), education and preparation for renal replacement therapy (RRT) remain suboptimal. We conducted a pilot study to evaluate the impact of a virtual multidisciplinary care program including a nurse, dietitian, pharmacist, and peer mentors for patient education, monitoring, and managing transitions to RRT.

Methods

We invited adults with eGFR <30 ml/min/1.73m2 not on RRT from a community-based nephrology clinic into Cricket Health’s online multidisciplinary care program. We compared CKD knowledge, confidence in disease self-management, and first choice of RRT modality before and after education. Then, in a matched prospective cohort design, we evaluated the association of program participation with planned RRT initiation (in-hospital vs. outpatient planned) after 9 months using conditional logistic regression. For each participant, we identified 1 to 2 controls from the same clinic, matched on age, gender, baseline eGFR, diabetes, and heart failure status.

Results

Among 50 invited, 37 (74%) enrolled, with average age 66 (SD=13), eGFR 19 ml/min/1.73m2 (SD=6), 68% female, and 53% diabetic. 36 participants (97%) completed a pre-program survey, and 23 (62%) completed a post-education survey. After education, the average percent correct on a 7-item CKD knowledge assessment increased from 52% to 89%, p<0.001. The percent reporting confidence in self-care dialysis was 83% after education, compared with 64% prior, p=0.22. Before education, 50% were unable to choose a RRT modality. After education, 91% of respondents made a choice, of whom 76% preferred a home RRT modality. At 9 months, 5 program participants and 5 controls started RRT. A total of 4 of 5 program participants (80%) started RRT as outpatients with planned starts, compared with 1 of 5 controls (20%) (OR=6.3, 95% CI=0.7-57, p=0.06).

Conclusion

A virtual multidisciplinary care program for persons with advanced CKD improves patient CKD knowledge, confidence in self-care, and interest in home RRT. Our findings also suggest this virtual multidisciplinary care program may increase the likelihood of planned RRT initiation.