Participation in a CKD Navigator Program Is Associated with Improved Quality of Dialysis Starts
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Rimmer, Jeffrey M., University of Vermont, Burlington, Vermont, United States
Initiation of chronic dialysis is frequently accompanied by the use of central venous catheters, hospitalisation and need for in-center hemodialysis. Optimal start dialysis with a permanent access, in an oupatient setting and with the patient's choice of modality is suggested to improve patient quality of life as well as reduce complications and cost. Education, coaching and monitoring of patients as they approach End-Stage Kidney Disease (ESKD) are proposed to increase the probability of optimal starts.
The University of Vermont Medical Center (UVMMC) began enrolloing persons with an eGFR < 20 ml/min/1.73m2 in a CKD navigator program in November 2020. The program provides education, assessment, planning, coaching and monitoring. From November 2020 through April 2023, 270 patients were approached to participate, 180 agreed (67% engagement rate) and 127 had completed a plan for ESKD and were being monitored. During this same period, 141 UVMMC patients started dialysis, 33 of whom were followed in the navigator program. The 141 starts were assessed for a permanent access (PermAcc), outpatient location (OP) and whether they were in a home program (HOME) then grouped according to participation in the program (NAV) or not (NoNAV). Starts with the combinationof PermACC+OP and PermAcc+OP+Home were also compared. The significance of differences between groups was assessed by Chi Square analysis with Yates correction when appropriate.
For numerical results see findings in Table. Patients participating in the navigator program were statisically more likely to start with a permanent access and in a home program. Combinations of these characteristics with an outpatient start also were statistically more common in navigator participants. Starting dialysis in an outpatient setting as a single finding was not different between groups.
Although lacking radomization, this observational study supports the proposal that patient participation in a CKD navigator program improves the quality of dialysis starts.
Characteristics at Dialysis Start
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