Abstract: PUB148
Impact of Dialysis Modality Selection Clinic
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Author
- Shetty, Anupkumar, Dallas Nephrology Associates, Dallas, Texas, United States
Group or Team Name
- Dallas Nephrology Associates.
Background
President Trump’s Executive Order on Advancing American Kidney Health has led to ESRD Treatment Choices (ETC) Model taking effect on January 1, 2021, to promote greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD in order to preserve or enhance their quality of care while reducing Medicare expenditures. ETC model and other related models have put tremendous pressure to grow home dialysis programs and Dallas Nephrology Associates (DNA) started ‘CKD Modality Selection Clinic’ in 2022 to address this. DNA is a single specialty nephrology practice having 110 nephrologists and 15 nephrology offices in Dallas Fort Worth area.
Methods
DNA’s CKD Modality Selection Clinic involves a 40 minute visit offered to patients in late stage CKD 4 and CKD 5 before they commit to a dialysis modality. During the initial 20 minutes, they were given a dialysis modality education booklet and were shown a video on dialysis modality education. Subsequent 20 minutes were dedicated to a physician visit involving history taking, focused examination and discussion of certain key elements shown in the video using the demo manequins with PD catheters, demo PD cyclers and demo NxStage machines. An assessment was made regarding dialysis modality selection both by the nephrologist and the patient. Patients were asked to choose a dialysis modality before and after the clinic. Patients were followed by the primary nephrologist and the final ESRD treatment selection was noted when they went on dialysis.
Results
The clinic was started in May 2022 and as of April 2023, clinic has been started in 7 offices. 209 patients have attended this clinic so far. In the pre-clinic questionnaire, 47.8% were uncertain about their dialysis modality selection and post-clinic questionnaire showed that 15.8% were uncertain. As of May 2023, among those who attended the modality selection clinic, 12 patients started home dialysis and 3 started in center hemodialysis.
Conclusion
Modality selection helps people make decision about dialysis modality selection. Educated patients chose home dialysis more often than those who do not take advantage of education.