Abstract: SA-PO1210
Nephrology Care and Kidney Replacement Therapy (KRT) Decision Readiness Among Rural Veterans with Advanced CKD: A Multicenter Study
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Shukla, Ashutosh M., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Wadhwa, Anuradha, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Agarwal, Adhish, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Parmar, Cydney El Cid, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Davis, Cornesia Dejuan, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Subhash, Shobha, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Shell, Popy, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Campbell-Montalvo, Rebecca, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Freytes, I. Magaly, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
Background
The Wheel and Spoke healthcare model and heterogeneous care patterns across VA cause significant specialty care concerns for rural Veterans. We lack broadly applicable real-world evaluations regarding rural Veterans’ state of advanced CKD care and KRT decision readiness.
Methods
We conducted a prospective study across 5-diverse VA centers to evaluate rural Veterans’ state of advanced CKD specialty care, KRT decision readiness and its determinants. We identified Veterans with advanced CKD through an EHR query, mail-invited them for a needs-assessment evaluation, and enrolled interested participants for KRT decision readiness evaluation by their ability to select KRT modality and confidence level of selection – with high-quality decision defined as >60% confidence – and home dialysis choice.
Results
We approached 1,819 Veterans with advanced CKD across study sites, of which 1053(58%) participated in needs-assessment evaluations, and 516 (28%) provided KRT preferences. Limited sociodemographic characteristics influenced participation bias; non-participants were older, rural Veterans engaged in needs assessments at higher rates but provided KRT preferences at lower rates(P<0.05). Half(57%) reported receiving KRT-directed information, but only 43(7%) CoPE classes. Minority(38%) were KRT decision ready, with 22% having high-quality KRT decisions, and 18% selecting home dialysis. Objective disease knowledge and declining kidney function were significantly associated with KRT decision readiness, decisional quality, and home dialysis selection. The odds of KRT decision readiness were 5-fold (OR:5.46, 95%CI:2.87, 10.77) higher in the top-tertiles of CKD-specific and 10-fold (OR:9.69, 95%CI:5.17, 18.81) higher in the top-tertiles of KRT-specific knowledge, compared to respective bottom-tertiles. Neither rurality nor geographical site had significant associations with Veterans’ awareness, kidney care quality, or KRT decision readiness parameters.
Conclusion
Veterans with advanced CKD have substantial specialty care deficits and poor KRT decision readiness; and these care deficits persist across Veteran’s rurality status and geographically diverse VHSs across the country.
Funding
- Other U.S. Government Support