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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.

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Kidney Week

Abstract: SA-PO627

It Takes Time: Developing a Standardized Strategy to Improve Timely Modality Education and Home Dialysis Choice Rates in Patients with Advanced Kidney Disease in Toronto, Canada

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Lu, Declan, University of Toronto, Toronto, Ontario, Canada
  • Zheng, Sijia, University of Toronto, Toronto, Ontario, Canada
  • Paterson, Bailey, University of Toronto, Toronto, Ontario, Canada
  • Dubrofsky, Lisa, University of Toronto, Toronto, Ontario, Canada
  • Auguste, Bourne L., University of Toronto, Toronto, Ontario, Canada
Background

Patients with progressive chronic kidney disease (CKD) should receive timely education that allows them to choose a treatment path that aligns with their care goals and lifestyle. Home-based dialysis modalities have been associated with increased quality of life and reduced health care costs. Modality education has been shown to increase rates of home dialysis as the initial dialysis strategy. Delays in timely education may reduce home dialysis choice rates. Barriers to timely modality education include lack of a standardized referral process, physician practice variation and patient preparedness to engage in discussion. The aim of this study was to assess whether the implementation of a standardized referral process could increase the rates of timely modality education and home dialysis choice.

Methods

This was a quality improvement study performed at a single center in Toronto, Canada between 2019-2023. Patients with a 2-year Kidney Failure Risk Equation (KFRE2) of >= 40% were recommended for modality education as outlined by the provincial regulatory body. Rates of modality education and home dialysis choice were recorded on a quarterly basis both before and after implementation of a standardized referral process.

Results

1451 encounters were identified between 2019-2023. Prior to initiation of a standardized referral process, 647/1134 (57.1%) of eligible patients received modality education and 218/647 (33.7%) of educated patients choose home dialysis as their preferred modality. After initiation of a standardized referral process, 177/317 (55.8%) of eligible patients received modality education and 54/177 (30.5%) of patients choose home dialysis as their preferred modality.

Conclusion

There was no significant change in modality education or home dialysis choice rates after initiation of a standardized strategy. Timing of education should not be restricted to arbitrary cut-off values but requires ongoing mentorship and support of patients at an early stage of disease course.