Abstract: SA-OR090
Trial to Evaluate and Assess Effects of Comprehensive Kidney Replacement Therapy (KRT)-Directed, Pre-ESKD Education (CoPE) on Home Dialysis Among Veterans (TEACH-VET): Evaluating KRT Decision-Making State (KDS) Outcomes
Session Information
- Late-Breaking Research Orals - 3
November 08, 2025 | Location: Grand Ballroom C, Convention Center
Abstract Time: 04:54 PM - 05:06 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Parmar, Cydney El Cid, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Freytes, I. Magaly, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Guo, Yi, University of Florida, Gainesville, Florida, United States
- Jia, Huanguang, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background
KRT-directed education is associated with higher home dialysis selection; however, ideal method of education and its impact on KRT decisional state hasn't been evaluated, limiting standardization efforts and guideline development
Methods
TEACH-VET, a randomized trial, aims to evaluate impact of active two-stage CoPE(initial navigator-led, decision-aid-assisted education followed by clinician-led lifestyle discussions) vs. EUC, i.e, usual care enhanced by passive provision of freely available KRT informational material, on several CKD and ESKD outcomes. We report a priori planned intent-to-treat analysis analyzing full KDS dataset(n=530) aimed to evaluate effect of CoPE(vs. EUC) on KDS, consisting of decision readiness, i.e., ability to select any KRT, decisional quality, with informed selection defined as KRT selection with >60% confidence, and home dialysis selection
Results
There were no significant differences in patient variables, including KDS between CoPE(n=275) and EUC(n=255) arms. Compared to EUC, CoPE recipients had significantly higher(P<.001) ability of any KRT selection(96% vs 68%), informed KRT selection(93% vs 44%) and home selection(82% vs 36%, Table1). While KDS significantly improved in both arms, CoPE increased any KRT selection, informed selection, and home selection by 41-90-fold(P<.001) and EUC increased these selections by 3-folds(P<.001). The odds ratio(95% confidence interval) for ability of any KRT selection was 12.8(6.5, 25.3), informed KRT selection was 18.9(9.5, 37.8), and home dialysis selection was 20.4(10.3, 41.0) for CoPE compared to EUC recipients. Mechanistic analyses show that KRT-related knowledge improvement was the strongest predictor of KDS
Conclusion
Structured active CoPE is more effective than passive KRT information provision in improving KRT decisional state – 9 of 10 advanced CKD patients achieve high quality KRT selection and 8 of 10 select home dialysis – advocating a change in clinical guidelines
| KDS parameters | Baseline KDS n(%) | Post-EUC KDS n(%) | After vs. Before EUC: OR(95%CI) | Post-CoPE KDS n(%) | After vs. Before CoPE: OR(95%CI) | Efficacy of CoPE (vs. EUC):OR(95%CI) |
| Not able to select | 314 (59%) | 83 (33%) | Ref | 10 (4%) | Ref | Ref |
| Able to select KRT modality | 216 (41%) | 172 (67%) | 2.8 (1.9, 4)* | 265 (96%) | 41.6 (21.2, 81.8)* | 12.8 (6.5, 25.3)* |
| Informed KRT selection | 107 (20%) | 92 (36%) | 3.2 (2.1, 4.9)* | 226 (82%) | 67.8 (33.6, 136.8)* | 20.4 (10.3, 41)* |
| Home modality selection | 106 (20%) | 111 (44%) | 3.3 (2.2, 5)* | 253 (92%) | 90.4 (44.5, 183.9)* | 18.9 (9.5, 37.8)* |
* P<.001; KRT modality includes conservative care
Funding
- Veterans Affairs Support