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Kidney Week

Abstract: PO1188

Status and Trajectory of Patient Activation Among Incident Dialysis Patients in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Carrasco, Anna Rosa, Satellite Healthcare, San Jose, California, United States
  • Bennett, Paul N., Satellite Healthcare, San Jose, California, United States
  • Watson, Emily, Satellite Healthcare, San Jose, California, United States
  • Sun, Sumi J., Satellite Healthcare, San Jose, California, United States
  • Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States

Patient activation (PA), a measure of knowledge, skills and confidence in managing one’s health, is associated with healthy behaviors, better disease management and improved health outcomes. We investigated the status and correlates of PA among end-stage kidney disease (ESKD) patients at dialysis initiation, and changes in PA after the first 3 months of dialysis.


Adult ESKD patients commencing dialysis at 25 in-center hemodialysis (ICHD) and 12 home dialysis facilities completed the Patient Activation Measure 13-item instrument (PAM-13) at dialysis initiation (t0) and month 4 (t1). Logistic regression was used to examine factors associated with high PA levels at t0 (PAM levels 3 and 4). Paired t-test was used to examine changes in PAM scores from t0 to t1.


227 patients completed the survey at t0 between Jun – Nov 2019; 166 (73%) on ICHD and 61 (27%) on home dialysis, mean age 60 ± 15 years. At t0, mean PAM scores were 65.1 ± 16.8; and 44% of patients had low activation. Mean PAM scores were 63.7 ± 17.3 and 69.4 ± 14.5 in ICHD and home patients respectively. In the adjusted model, higher education level and longer pre-ESRD nephrology care were associated with high PA at t0, while increased age was associated with lower odds of high activation – Figure 1. There was no significant change in PA scores among 182 participants who completed the survey at t1 (mean 64.8 ± 17.8, mean change: -0.3 ± 17.3, p = 0.80).


Low activation is common among incident dialysis patients and is more common among those on ICHD. Patient activation does not seem to improve over the first 3 months of dialysis with current practice.

Figure 1: Adjusted odd ratios of high activation among incident dialysis patients