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Kidney Week

Abstract: FR-OR11

Association of Use of Kidney Disease Education Benefit with ESKD-Related Outcomes

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Johansen, Kirsten L., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Weinhandl, Eric D., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Liu, Jiannong, Chronic Disease Research Group, Minneapolis, Minnesota, United States

ESKD onset in the US is marked by poor outcomes, including little use of home dialysis, widespread catheter dependence among patients on hemodialysis, and high mortality. Consequently, in 2010, the Centers for Medicare and Medicaid Services (CMS) initiated a new kidney disease education (KDE) benefit to ensure that beneficiaries with stage 4 CKD are informed about the effects and treatment of kidney disease, diet and nutrition, transplantation, dialysis modalities, and vascular access. Following the US president’s Executive Order on Advancing American Kidney Health in 2019, CMS plans to expand KDE. However, the current use and efficacy of KDE have not been examined.


We used USRDS data to identify eligible patients and to ascertain KDE and ESKD outcomes. We examined use of KDE in the 2 years prior to ESKD onset in 2013-2017 among 106,465 individuals aged ≥67 years who had CKD stage 4. We examined patient characteristics associated with receipt of KDE. We matched each KDE recipient with 4 controls using propensity scores and estimated the association between receipt of KDE and ESKD outcomes in this matched cohort using logistic regression.


3171 patients (3%) received KDE, 56% of whom received a single session. 49.5% of KDE sessions were delivered by nephrologists and 42% by physician extenders. Younger patients, men, and non-Hispanics were more likely to receive KDE. There was substantial regional variation in KDE utilization, and rural residents were less likely to receive KDE. In the matched cohort, receipt of KDE was associated with higher odds of transplant waitlisting before dialysis initiation, pre-emptive transplantation, home dialysis, or in-center HD initiation with an AVF or AVG (vs. catheter; Table).


A very small percentage of eligible patients reaching dialysis receive Medicare-reimbursed KDE within the previous 2 years. KDE was associated with favorable outcomes, at least among those who advanced to ESKD.

OutcomeKDENo KDEOR (95% CI)
Transplant waitlisting prior to ESKD4.02.91.41 (1.15 - 1.74)
Pre-emptive transplant1.91.41.34 (1.00 - 1.80)
Home dialysis18.111.51.70 (1.53 - 1.89)
Hemodialysis with AVF or AVG41.626.32.00 (1.84 - 2.19)
Optimal ESKD start* (1.90-2.23)

*Pre-emptive transplant or home dialysis or in-center HD with AVF or AVG


  • NIDDK Support