ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: TH-PO871

Unraveling the Hemodialysis Patient Network: Results from the Social Network and Renal Education (SNARE) Transplant Intervention

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Gayner, Alec, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Gillespie, Avrum, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Reese, Peter P., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Gadegbeku, Crystal A., Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Calvelli, Hannah, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Gardiner, Heather Marie, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Fink, Edward L., Temple University, Philadelphia, Pennsylvania, United States
Background

In-center Hemodialysis (HD) is a unique therapy occurring in a group setting, facilitating patient social network formation. Social networks are a key social determinant of health, amenable to intervention if influential members are identifiable. The goal of our study is to determine whether patients who are more clustered (a network member whose alters are interconnected) vs. more central (a network member who has multiple alters who are not interconnected) within HD networks are more likely to disseminate the COmmunicating About Choices in Transplant (COACH) intervention. This intervention has been shown to improve knowledge, communication skills, and behaviors regarding living/deceased-donor kidney transplantation (KT).

Methods

For this pilot network intervention clinical trial (NCT03536858), in a North Philadelphia HD clinic, the Monday, Wednesday, Friday patients were stratified to centrality spread and Tuesday, Thursday, Saturday to clustering spread. Outcomes including number of transplant evaluation steps completed, change in KT knowledge, self-reported KT conversation self-efficacy, and living donation requests were assessed using repeated questionnaire data and chart review prior to the intervention, at 3-months, and 9-months post-intervention. Data analysis was performed using t-tests, repeated measures ANOVA, and Fisher’s exact test.

Results

Twenty-eight transplant-eligible patients completed the study. Groups (centrality N=11; clustering N=17) did not differ significantly in demographic or clinical variables. The clustering group completed more KT evaluation steps (+0.79 ± 1.72 vs -0.38 ± 1.3, p=0.02) and reported higher conversation self-efficacy scores than the centrality group (21± 2.6 vs.16 ± 1.4, p=0.03). The difference in living KT requests was not significant (3 vs 1, p=0.5). No differences were observed in knowledge outcomes.

Conclusion

Selection of patients with the highest clustering yielded more efficient dissemination of the COACH intervention. Notably, this network intervention improved transplant behaviors but not knowledge, indicating a peer-network imitation effect on behaviors without changing knowledge. Further research is indicated to assess these effects in a larger population and with expanded network targeting strategies.

Funding

  • NIDDK Support