Kidney Week

Abstract: FR-PO1080

Veterans' Preferences and Participation Patterns for Receiving Comprehensive KRT-Directed Patient Education (CoPE): A Prospective Multisite Cohort Study

Session Information

• Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Wadhwa, Anuradha, Edward Hines Junior Veterans Affairs Hospital, Hines, Illinois, United States

Anuradha Wadhwa, MD, FASN

• Subhash, Shobha, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Shobha Subhash, MPH

• Parmar, Cydney El Cid, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Cydney El Cid Parmar, MPH

• Davis, Cornesia Dejuan, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Cornesia Dejuan Davis, MPH

• Shell, Popy, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Popy Shell, MPH

• Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Ashutosh M. Shukla, MD, MBBS, FASN

Background

CoPE is recommended for advanced CKD patients for informed Kidney Replacement Therapy (KRT) and home dialysis decisions, yet <10% receive it. The reasons for this low uptake are unclear, including whether it reflects limited access to CoPE services or differences in patient preferences. This prospective, multi-state needs assessment study compared CoPE preferences between rural and urban Veterans.

Methods

Veterans with CKD stage 4/5 were identified via EHR at 5-Veterans Healthcare System in FL, IL, UT (n=1836), and mail-invited for the study. In Step1, we conducted a needs-assessment of their current renal care. In Step2, CoPE was offered. We recorded participation rates and non-participation reasons (not reachable, not interested, access barriers, clinical status limiting ability, education/information barriers) comparing rural-urban differences.

Results

Of 1836 invited Veterans,1066 participated in needs assessment and 433 agreed for CoPE. Step1 reasons for overall non-participation were, non-reachable (n=379,49%), not interested (n=217,28%), clinical status (n=134,18%). Rural Veterans had significantly higher non-reachability (56% vs 45%, p<0.01); urban Veterans had higher non-interest (31% versus 23%,p<0.001).
Step2 (CoPE non-participation) reasons were not interested (n=202,32%), non-reachability (n=126,20%), clinical status (n=123,19%). Urban Veterans had higher clinical barriers (27% vs 13%, p<0.01); rural Veterans had higher non-interest (37% vs 26%, p<0.001). Rural Veterans had approximately 1.6 times the rate of access barriers compared to urban Veterans (14% versus 9%, p<0.05).

Conclusion

Less than quarter of eligible Veterans, and less than half of those offered, chose to receive CoPE. System-level interventions are needed, particularly for rural Veterans. Principal, among these are improving engagement and education at primary care level and addressing health literacy and knowledge barriers at patient level, underscoring the need for KRT education to support shared decision making

Acknowledgment

The 'Align for Kidney Failure Care' study includes the following site PIs:
Dr. Ashutosh Shukla, Dr. Anuradha Wadhwa, Dr. Adhish Agarwal, Dr. Scott Reule, Dr. Linda Fried, Dr. Kerri Cavanaugh, Dr. Mona Brake, Dr. Melissa Swee, Dr Puneet Garg, Dr. Rajiv Saran

Funding

• Veterans Affairs Support