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Kidney Week

Abstract: TH-PO1137

Peer Mentorship to Reduce Hospitalizations Among Patients Receiving Maintenance Hemodialysis: Results of the PEER-HD Trial

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Golestaneh, Ladan, Albert Einstein College of Medicine, Bronx, New York, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
  • Kim, Ryung S, Albert Einstein College of Medicine, Bronx, New York, United States
  • Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Hospitalizations contribute to up to 40% of the cost of care among patients receiving maintenance dialysis. PEER-HD is a pragmatic trial to test the impact on ED visit and hospitalization rates of a peer mentor led intervention in patients receiving hemodialysis.

Methods

This is a multi-center randomized controlled trial of 194 patient-participants (134 in Bronx NY and 60 in Nashville TN). Fourteen mentor-participants were recruited and trained. Patient-participants, identified as having high risk of hospitalization, were then recruited from affiliated dialysis facilities and those assigned to intervention (n=99) were matched to mentors. Mentors placed weekly telephone calls to assigned mentees over 3 months, after which patient-participants were observed for up to 15 months. The number of per patient-participant composite events during follow-up was recorded (median 12 months, range 2-18 months). The comparison of primary outcome between the intervention and usual care groups was made using Poisson regression with log of follow-up time as offset. Because there was significant interaction by study site we stratified the analyses.

Results

The mean age was 51.7 years, 51.5% were female, 56.2 % self-identified as Black and 39.2% self-identified as Hispanic. Baseline characteristics did not differ between randomized groups.
The rates of ED visits and hospitalizations were 0.17 per patient-month in intervention group and 0.20 per patient-month in usual care group (incident rate ratio (IRR)=0.86; CI 0.70-1.06, p=0.15). Among the 134 patient participants in Bronx, NY there was a significantly lower rate of outcome in those assigned to intervention as compared to usual care (IRR= 0.70; CI 0.54-0.90; p=0.007). Among the 60 patients from Nashville, TN the difference in primary outcome was not significantly different (IRR= 1.25; CI 0.89-1.76, p=0.20). Post-hoc analysis showed that removal of 1 medically complex outlier made significant the overall effect of the intervention on outcome (IRR=0.85; CI 0.86-0.96, p=0.02).

Conclusion

Peer mentorship was not effective overall in reducing rate of hospitalization and ED visits, but was effective in Bronx NY. The protective effect of peer mentorship may be population specific, affected by area practice patterns or related to differences in mentoring activities.

Funding

  • NIDDK Support