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Abstract: SA-PO944

Patient Navigators for CKD and Kidney Failure: A Systematic Review

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Collister, David Thomas, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Iman, Yasmin A., University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  • Bohm, Clara, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
Background

To what degree and how patient navigators improve clinical outcomes for patients with chronic kidney disease (CKD) and kidney failure is uncertain. We performed a systematic to summarize patient navigator program design, evidence, and implementation in kidney disease.

Methods

A search strategy was developed for randomized controlled trials and observational studies that evaluated the impact of navigators on outcomes in the setting of CKD and kidney failure. Articles were identified from various databases. Two reviewers independently screened the articles and identified those which met the inclusion criteria. Data was abstracted from full texts and risk of bias was assessed.

Results

After screening a total of 3371 citations, 17 articles met the inclusion criteria including 14 original studies. Navigators came from various healthcare backgrounds including nursing (n=6), social worker (n=2), medical interpreter (n=1), research (n=1) and also included kidney transplant recipients (n=2) and non-medical individuals (n=2). Navigators focused mostly on education (n=9) and support (n=6). Navigators were used for patients with CKD (n=5), peritoneal dialysis (n=2), in-center hemodialysis (n=4), kidney transplantation (n=2) but not home hemodialysis. Navigators improved transplant workup and listing, adherence, peritoneal dialysis utilization and patient knowledge. However, many studies did not show benefits across other outcomes, were at a high risk of bias, and none reported cost effectiveness or patient reported experience measures.

Conclusion

Navigators improve some health outcomes for CKD but there is heterogeneity in their structure and function. High-quality randomized controlled trials are needed to evaluate patient navigator program efficacy and cost effectiveness.